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THE   PRINCIPLES 

OF 

HYGIENE 

A  Practical   Manual  for   Students, 

Physicians,  and  Health-Officers 

'  \       i   •         BY 
D.  ft:  BEKGEY,  A.M.,  M.D. 

First  Assistant,  Laboratory  of  Hygiene, 
University  of  Pennsylvania 

ILLUSTRATED 

PHILADELPHIA  AND  LONDON 

W.  B.  SAUNDERS  &  COMPANY 
1901 


Copyright,  1901 
By  W.  B.  SAUNDERS    &  COMPANY. 


Registered  at  Stationers'  Hall,  London,  England. 


ELECTROTYPED    BY  PRESS    OF 

WESTCOTT    Sc    THOMSON,   PHILADA.  W.  B.  SAUNDERS    &   COMPANY. 


PREFACE. 


This  book  has  been  prepared  to  meet  the  needs  of 
students  of  medicine  in  the  acquirement  of  a  knowledge 
of  those  principles  on  which  modern  hygienic  practices 
are  based ;  to  aid  students  in  architecture  in  comprehend- 
ing the  sanitary  requirements  in  ventilation,  heating, 
water-supply,  and  sewage-disposal;  and  to  aid  physicians 
and  health  officers  in  familiarizing  themselves  with  the 
advances  made  in  hygienic  practices  in  recent  years. 

The  rapid  strides  made  in  our  knowledge  of  the  entire 
subject  of  hygiene  has  rendered  such  a  book,  based  upon 
the  more  recent  discoveries,  almost  a  necessity  to  students 
of  medicine. 

No  attempt  has  been  made  to  treat  the  subject  in  an 
exhaustive  manner,  the  object  being  merely  to  give  the 
general  principles  upon  which  the  health  officer  and  the 
physician  work  in  their  respective  capacities  in  dealing 
with  conditions  which  are  detrimental  to  health  or  which 
tend  to  improve  health. 

The  entire  range  of  subjects  comprising  the  compre- 
hensive field  of  hygiene  has  not  been  discussed,  but  all 
those  subjects  which  appeared  to  the  author  to  be  most 
important  for  those  for  whom  the  book  has  been  pre- 
pared have  received  the  consideration  which  their  relative 
importance  demanded. 

The  metric  system  of  weights  and  measures  has  been 
employed  throughout  the  work    except    in    quotations, 


IO  PREFACE. 

because  this  system  is  now  in  general  use  in  all  scientific 
laboratories  in  the  United  States,  and  because  it  is  in 
every  way  preferable  to  the  cumbersome  and  complicated 
system,  with  its  various  units,  which  is  still  in  common 
use.  The  metric  system  was  employed  also  because  it  is 
in  common  use  on  the  Continent  of  Europe,  and  is  also  a 
legal  system  in  the  United  States  since  1866,  when  Con- 
gress passed  an  act  making  its  use  lawful  in  the  construc- 
tion of  contracts  and  in  all  legal  proceedings.  It  is 
rapidly  coming  into  general  use  in  medicine  and  phar- 
macy, and  its  general  adoption  has  the  hearty  endorse- 
ment of  numerous  scientific  societies.  At  the  present 
time  a  bill  is  passing  through  Congress  which,  when 
enacted,  will  make  its  employment  compulsory  in  all 
departments  of  the  Government  after  January  1,  1903. 
In  the  Appendix  the  relative  values  of  the  units  of 
weights  and  measures  of  the  metric  system  have  been 
given  in  terms  of  the  English  system,  and  vice  versa. 

D.  H.  B. 
August,  1901. 


CONTENTS. 


PAGE 

Introduction r7 

Causes  of  Disease,  17. — Sanitary  Science,  27.— Hygiene,  27. 

CHAPTER    I. 
Air 31 

Nature  and  Composition  of  the  Atmosphere,  31.— Temperature  of 
the  Air,  33. — Pressure  of  the  Atmosphere,  34. — Distribution  of  At- 
mospheric Pressure,  36. — Humidity  of  the  Atmosphere  ;  Hygrometry, 
37. — Elastic  Force  of  Vapor,  39. — Absolute  Humidity,  40. — Rela- 
tive Humidity,  40. — The  Influence  of  Humidity  on  Health,  40. — 
Precipitation  of  Moisture,  42. — Climate,  42. — Ground-air,  48. — 
Sewer-air,  48. — The  Impurities  in  the  Air,  49. — Examination  of  the 
Air  by  the  Senses,  54. — Chemical  Analysis  of  the  Air,  55. — Diseases 
Produced  by  Impure  Air,  55. — Effects  of  Vitiated  Air  Generally,  56. 

CHAPTER    II. 

Ventilation 59 

Amount  of  Fresh  Air  Required,  59. — Cubic  Space,  61. — General 
Rules  for  Ventilation,  63. — Natural  Ventilation,  63. — Arrangements 
in  Natural  Ventilation,  65. — Artificial  Ventilation,  74. — Removal  of 
Dust,  78. 

CHAPTER    III. 

Heating 82 

Loss  of  Heat  from  Buildings,  82. — Degree  of  Warmth,  82. — Heat 
Supplied  by  Radiating  Surfaces,  83. — Systems  of  Heating,  85. — 
Direct  Radiation,  86. — Indirect  Radiation,  89. 

CHAPTER    IV. 

Water  and  Water-supply 92 

Physical  Properties  of  Water,  92. — Chemical  Composition,  92. — 
Rain-water,  93. — Spring-water,  93. — Well-water,  94. — River-water, 
94. — Lake-water,  95. — Sea-water,  95. — Comparison  of  Natural 
Waters,  95. — Impurities  in  Water,  96. — Effects  of  Impurities  in 
Water,  100. — Dissolved  Solid  Impurities,  100. — Approximate  Com- 
position of  Drinking-water,  105. — Amount  of  Drinking-water  Re- 
quired Daily,  106. — Source  of  Water-supplies,  107. — Storage  of 
Water,  11 1. — Purification  of  Water,  in. — Methods  of  Purification, 
112. — Suitability  of  Water  for  Boiling  Purposes,  132. — Standard 
Method  of  Water  and  Sewage  Analysis,  133. 

11 


12  CONTENTS. 

CHAPTER   V. 

PAGE 

The  Removal  and  Disposal  of  Sewage 147 

The  Removal  of  Sewage,  147. — Water-closets,  -147. — Traps,  150. 
— Disposal  of  Sewage,  154. — Chemical  Treatment  of  Sewage,  185. 
— Modern  Methods  of  Sewage  Purification,  157. — Summary  Con- 
cerning Sewage  Purification  Plants  now  in  Operation  in  America, 
166. — The  Removal  of  Sewage  by  Liernur  System,  170 Com- 
mercial Value  of  Sewage,  171. 

CHAPTER   VI. 
Garbage  Disposal 173 

Collection  and  Removal  of  Garbage,  174. — Disposal  of  Garbage, 
175- 

CHAPTER   VII. 

Food  and  Dieting 178 

Chemical  Composition  of  the  Body,  178. — Potential  Energy  in 
Food,  180. — Energy  Derivable  from  Food,  182. — Nutritive  Value 
and  Cost  of  Food,  188. — Digestibility  of  Foods,  190. — Composition 
of  Foods,  192. — Functions  of  the  Alimentary  Principles  of  Food, 
193. — Water  as  Food,  194. — Different  Varieties  of  Food,  195. — 
Animal  Foods;  Meat,  195. — Fish,  205. — Milk  and  Milk-products, 
205. — Vegetable  Foods,  218. — Bread,  220. — Preserved  Vegetable 
Foods,  221. — Food  Preservatives,  222. — Mineral  Food,  222. — Bever- 
ages and  Condiments,  223. — Adulterations  of  Food,  225. — Dietaries, 
228. 

CHAPTER   VIII. 
Exercise 233 

Effect  on  the  Lungs,  233. — Effect  on  the  Circulation,  235. — Effect 
on  the  Muscles,  236. — Effect  on  the  Nervous  System,  237. — Effect  on 
the  Elimination  of  Nitrogen,  237. — Amount  of  Exercise  that  should 
be  Taken,  238. 

CHAPTER    IX. 
Clothing 241 

Protection  against  Cold,  241. — Protection  against  Heat,  242. — Pro- 
tection against  Dampness,  242. — Protection  against  Injury,  243. — 
Injurious  Effects  of  Clothing,  245. — Cleanliness  in  Relation  to 
Clothing,  246. 

CHAPTER    X. 
Personal  Hygiene ,    .    248 

Cleanliness,  249. — The   Bowels,  249. — The   Passions,  249. — The 
Mouth  and  Teeth,  249. — Habitation,  250. — Occupation,  250. — Mental 
.  Attitude,  251. 


CONTENTS.  13 

CHAPTER   XI. 

PAGE 

Industrial  Hygiene 252 

Influence  of  the  Length  of  the  Working-day  on  the  Health  of 
the  Laborers,  264. — Lighting  of  Industrial  Establishments,  265. 

CHAPTER    XII. 

School  Hygiene 269 

Site,  or  Location,  with  Reference  to  Drainage  Capacity  of  the 
Soil,  269. — Structure  of  the  Walls,  270. — Cubic  Space  and  Floor 
Space,  270. — Relation  of  Window  Space  to  Floor  Space,  272. — 
Lighting,  273. — The  Position  of  Blackboards,  274. — Corridors, 
Cloak-rooms,  and  Wardrobes,  274. — Ventilation,  275. — Heating, 
276. — Water-supply  and  Sewage  Disposal,  277. — Water-closets  and 
Latrines,  277. — Desks  and  Seats,  278. — Defects  in  School-buildings, 
280. — Medical  Inspection  of  Schools,  281. 

CHAPTER   XIII. 
Military  Hygiene 286 

The  Recruit,  286. — Training  of  the  Recruit,  289. — Food  of  the 
Soldier,  290. — Clothing  of  the  Soldier,  292. — Camps,  295. — Barracks, 
299. — Marches,  300. — Camp  Diseases,  301. — Foot  Inspection,  302. — 
Body  Inspection,  303. 

CHAPTER   XIV. 

Naval  Hygiene 304 

Ventilation,  305. — Heating  of  the  Vessel,  307. — Lighting,  307. — 
Cleansing  the  Vessel,  307. — Water-supply,  308. — Food-supply,  308. — 
Clothing,  309. — SelecfidnTofMarines,  309. — Principal  Diseases  among 
Marines,  315. 

CHAPTER   XV. 

Soil 317 

Ground-air,  317. — Ground-water,  317. — Pathogenic  Bacteria  in 
Soil,  320. — Improvement  of  a  Damp  Soil,  320. — Configuration  of  the 
Surface  and  Soil-covering,  320. 

CHAPTER   XVI. 

Habitations 322 

Position  of  the  House,  322. — The  Foundation  and  Walls,  323. — 
The  Roof,  323. — The  Interior  Arrangement,  324. — The  Size  of  the 
Rooms,  324. — The  Sleeping-rooms,  325. — The  Floors  and  Floor- 
coverings,  325. — The  Wall -coverings,  326. — Ventilation  and  Heating, 
327. — Plumbing  and  Drainage,  328. — Houses  for  the  Poor.  328. — 
House-cleaning,  330. — Protection  from  Flies  and  Mosquitoes,  331. 


14  CONTENTS. 

CHAPTER   XVII. 

PAGE 

Vital  Causes  of  Disease 332 

Modes  of  Dissemination,  334. — Nature  of  Epidemics,  335. — Immu- 
nity and  Susceptibility,  336.— Prevention  of  Infection  by  Inducing 
Immunity,  351. — Value  of  Vaccination  as  a  Protective  against  Small- 
pox, 352.— The  Haffkine  Method  of  Protection,  356. — Personal  Pro- 
phylaxis, 357. — Persistence  of  Pathogenic  Bacteria  in  Dead  Bodies, 
360. — Prevention  of  Malaria,  360. — Prevention  of  Yellow  Fever,  362. 
— The  Animal  and  Vegetable  Parasites,  368. — Prevention  of  Infection 
with  Animal  Parasites,  369. 

CHAPTER   XVIII. 

Disinfection 372 

Disinfectants  in  Common  Use,  373. — Disinfection  on  Large  Scale, 
374. — Formaldehyd,  376. — -Generation  of  Formaldehyd  Gas,  376. — 
Sulphur  Dioxid,  379. — Hydrocyanic  Acid,  379. — Corrosive  Subli- 
mate, 380.— Carbolic  Acid,  380. — Trikresol,  381. — Creolin,  381. — 
Nitrate  of  Silver,  381. — Preparations  of  Lime,  381. — Washing  Soda, 
382. — Sulphate  of  Iron,  382. — Physical  Agents,  382. — Disinfection 
of  Infective  Materials,  383. — Disinfection  of  Excreta,  383. — Disin- 
fection of  Sick-room,  384. — Disinfection  of  Habitations,  387. — Dis- 
infection of  Patient,  388. — Instructions  for  Disinfection,  389. — Dis- 
infection of  Public  Conveyances,  390. 

CHAPTER  XIX. 

Quarantine 393 

Maritime  Quarantine,  393. — Inland  Quarantine,  394. — Isolation 
or  House  Quarantine,  395. — Value  of  Disinfection  and  Isolation,  395. 
— Period  of  Isolation,  399. — Period  of  Detention  of  Those  Exposed 
to  the  Infectious  Diseases,  399. — Maritime  Quarantine,  400. — Quar- 
antine Laws  of  the  United  States,  401. — Quarantine  Regulations  to 
be  Observed  at  Foreign  Ports  and  at  Sea,  408. — Quarantine  Regula- 
tions for  Domestic  Ports  to  Prevent  the  Introduction  of  Plague  from 
Santos  and  Oporto,  423. — Quarantine  Regulations  to  be  Observed  at 
Ports  and  on  the  Frontiers  of  the  United  States,  429. — Interstate 
Quarantine,  447. — State  Quarantine  Regulations,  453. — Regulation 
of  Travel  and  Traffic,  458. — House  Quarantine,  467. 

CHAPTER    XX. 
Vital  Statistics 470 

The  Census  as  a  Basis  for  Calculation,  472. — Standards  of  Age- 
distribution,  472. — Calculation  of  the  Birth-rate  and  the  Death-rate, 
474. — Rate  of  Infant  Mortality,  475. — Death-rate  of  Persons  Engaged 
in  Various  Occupations,  475. — Mortality  in  Relation  to  Seasons,  476. 
— Mean  Age  at  Death,  476. — Mean  Duration  of  Life,  476. — Probable 


CONTENTS.  IS 

PAGE 

Duration  of  Life,  477. — Expectation  of  Life,  477. — Relation  of 
Density  of  Population  to  the  Death-rate,  478. — Necessity  of  System 
of  Notification,  479. — Hospital  for  Infectious  Diseases,  480. 


Appendix 481 

Rules  for  Interchange  of  Different  Expressions  of  Results  of  Analy- 
sis, 481. — Rules  for  Conversion  of  Degrees  of  one  Thermometer 
Scale  into  those  of  Another,  481. — Rules  for  Conversion  of  Kilo- 
gram-meters into  Foot-pounds  and  Foot-tons,  and  vice  versa,  482. 
— Values  of  Terms  Employed  in  Connection  with  Fuel-value  of 
Food,  482. — Comparison  of  Metric  and  English  Weights  and  Meas- 
ures, 482. 


Index 485 


THE 

PRINCIPLES  OF  HYGIENE. 


INTRODUCTION. 


The  comprehensive  nature  of  the  subject  precludes 
the  possibility  of  giving  a  short  and  precise  definition. 
A  late  writer  on  hygiene  has  given  the  following  defini- 
tion :  "Hygiene  aims  to  make  growth  more  perfect,  life 
more  vigorous,  decay  less  rapid,  death  more  remote." 
Hence  hygiene  treats  of  the  laws  of  health  ;  of  all  those 
means  which  tend  to  preserve  the  body  in  a  healthy  con- 
dition, as  well  as  those  which  tend  to  improve  the 
general  health.  It  embraces  a  knowledge  of  the  factors 
and  conditions  which  bring  about  ill  health  and  disease, 
as  well  as  a  knowledge  of  the  best  means  of  preventing 
disease,  and  of  the  measures  which  tend  to  fortify  and 
improve  the  organism. 

Health  is  that  condition  of  the  body  in  which  all  the 
various  functions  are  performed  normally,  and  without 
the  manifestation  of  discomfort  in  any  of  its  operations. 
Disease,  on  the  other  hand,  implies  the  imperfect  per- 
formance of  one  or  more  of  the  bodily  functions  because 
of  the  impaired  structure  of  the  corresponding  organ  or 
organs,  and  the  consequent  manifestation  of  discomfort, 
either  in  the  part  directly  affected  or  in  the  body  generally. 

There  are  many  factors  which  may  operate  in  such  a 
manner  as  to  bring  about  disease.  These  factors  are 
usually  divided  into  the  immediate  and  remote  causes  of 
disease. 

The  immediate  causes  of  disease  may  be  again  divided 
into  three  classes,   physical,  chemical,    and  vital.     The 

2  17 


1 8  INTRODUCTION. 

physical  causes  of  disease  are  such  as  are  brought  about 
by  physical  agencies.  The  diseases  which  are  due  to 
physical  agencies  are  burns,  cuts,  bruises,  fractures,  and 
the  like,  and  those  diseases  of  the  respiratory  organs  due 
to  the  inhalation  of  various  forms  of  dust.  The  chemical 
causes  of  disease  are  corrosive  and  irritating  drugs  and 
chemicals  which  act  directly  through  their  corrosive  action 
upon  the  part  with  which  they  are  brought  in  contact, 
or  indirectly  through  action  upon  the  system  after  having 
been  absorbed  into  the  circulation.  The  vital  causes  of 
disease  are  the  most  important,  because  they  are  the  most 
numerous  and  are  frequently  communicated  from  the 
sick  to  the  well.  They  are  also  of  great  hygienic  im- 
portance, because  most  of  them  are  preventable.  The 
vital  causes  of  disease  which  are  known  to-day  are 
the  animal  and  vegetable  parasites  that  are  capable  of 
lodging  upon  the  surface  of  the  body  or  penetrating  into 
the  blood  and  tissues,  and  thus  give  rise  to  disordered 
function  either  by  producing  obstruction,  local  irritation, 
absorbing  large  quantities  of  nourishment  from  the  body, 
or  by  generating  highly  poisonous  secretion  and  excre- 
tion products  which  produce  disease  through  their  local 
or  general  action.  The  principal  animal  parasites  which 
produce  disease  are  the  various  forms  of  intestinal 
worms,  the  trichina  spiralis,  the  fllariae,  the  itch  mite, 
and  the  malarial  organisms.  The  principal  vegetable 
parasites  which  produce  disease  are  the  different  forms 
of  pathogenic  bacteria  and  the  plants  of  somewhat  higher 
order  which  produce  tinea  favosa  and  other  skin  diseases. 
The  remote  causes  of  disease  operate  in  such  a  man- 
ner as  gradually  to  reduce  the  physical  powers  of  the 
body,  so  as  to  make  it  possible  for  the  vital  causes  to 
operate.  The  remote  causes  of  disease  may  be  such  fac- 
tors as  undue  exposure  to  extremes  of  heat  and  cold, 
dampness  or  undue  dryness  of  the  atmosphere,  undue 
exposure  to  bright  lights  or  strong  currents  of  air  may 
operate  in  this  manner,  prolonged  absence  of  sunlight, 
deficient   ventilation,  the   use  of  excessive  amounts  of 


CAUSES  OF  DISEASE.  19 

certain  kinds  of  food  and  drink,  the  continued  use  of  a 
diet  which  is  deficient  in  one  or  more  of  the  elements 
which  enter  into  the  composition  of  the  body,  maintain- 
ing the  body  in  abnormal  positions  for  a  long  time, 
undue  physical  or  mental  exertion,  deprivation  of  food 
and  sleep,  and  wearing  of  apparel  which  constricts  cer- 
tain portions  of  the  body. 

The  causes  of  disease  may  also  be  divided  into  the  pre- 
disposing and  the  exciting  causes.  The  predisposing 
causes  of  disease  are  the  various  conditions  which,  by 
their  influence  upon  the  body,  render  it  less  resistant  to 
the  invasion  of  pathogenic  bacteria,  or  otherwise  pre- 
dispose to  disordered  health.  The  conditions  which  have 
been  classed  as  remote  causes  of  disease  also  belong  in 
this  class;  but  besides  these  there  are  other  important 
conditions  which  predispose  to  disease,  such  as  the  age 
and  sex  of  a  person,  hereditary  influences,  race,  conjugal 
condition,  the  hygienic  condition  of  the  environment, 
the  density  of  the  population,  the  nature  of  the  occupa- 
tion, and  the  climate  of  the  locality.  Dr.  Farr  found 
that  the  mortality  increases  with  the  density  of  the 
population,  but  not  in  direct  proportion  to  the  density, 
but  as  its  sixth  root. 

The  exciting  causes  of  disease  are  the  specific  elements 
which  are  the  etiologic  factors  in  the  production  of  dis- 
ease. These  are  synonymous  with  the  immediate  causes 
of  disease  in  the  first  classification,  the  physical,  chemi- 
cal, and  vital  causes  of  disease. 

Predisposing  Causes  of  Disease. — 1.  Age. — The  influ- 
ence of  age  is  a  most  important  factor  in  the  production 
of  disease.  The  age  groups  at  which  the  mortality  is 
greatest  are  to  be  found  in  the  periods  of  growth  and 
decline,  while  the  mortality  is  lowest  during  youth  and 
the  earlier  periods  of  adult  maturity.  The  highest  mor- 
tality occurs  among  children  under  one  year  of  age, 
and  then  decreases  rapidly  until  we  reach  the  fifteenth 
year,  after  which  it  again  gradually  increases  until  we 
reach  the  period  between  sixty  and  seventy  years,  when 


20 


INTRODUCTION. 


it  again  decreases.  The  following  table,  taken  from  the 
annual  reports  of  the  Bureau  of  Health  of  the  city  of 
Philadelphia,  shows  "the  percentage  of  deaths  to  total 
mortality  during  specified  periods  of  life,"  for  the  years 
1889  to  1894,  inclusive: 


Years. 

1889. 

1890. 

1891. 

1892. 

1893. 

1894. 

Per  ct. 

Per  ct. 

Per  ct. 

Per  ct. 

Per  ct. 

Per  ct. 

0-     1 

5268 

25-66 

5287 

24  33 

54S8 

23-49 

5693 

23.42 

5710 

24-13 

S472 

24-57 

1—    2 

1287 

6 

27 

I305 

6.00 

1439 

6 

ib 

1601 

6-59 

144b 

6.11 

13O3 

5 

90 

2-    5 

1197 

0 

83 

1320 

6 

07 

1552 

b 

04 

1004 

7.83 

1534 

6.49 

159b 

7 

02 

5-  10 

603 

.3 

23 

654 

3 

00 

978 

4 

19 

,1083 

4-45 

811 

3-42 

870 

3 

«3 

10-  15 

307 

1 

49 

322 

1 

48 

359 

1 

54 

362 

1.49 

353 

1.49 

330 

1 

45 

15—  20 

613 

2 

99 

5*7 

2 

71 

623 

2 

67 

601 

2.47 

584 

2.47 

540 

2 

40 

20-  30 

1027 

9 

38 

209=; 

9 

6S 

2022 

8 

OS 

2051 

8.44 

2079 

8.78 

1941 

8 

55 

30-  40 

1S24 

8 

88 

2018 

9 

29 

2047 

8 

76 

2173 

8.94 

211Q 

8.96 

1987 

8 

76 

40-  50 

10/3 

8 

15 

1 354 

8 

S3 

1812 

7 

75 

1863 

7.67 

2037 

8.62 

1918 

8 

45 

50-  60 

iSbi 

7 

60 

1717 

7 

9i 

1855 

7 

94 

1990 

8.19 

iqgo 

8.42 

1932 

8 

51 

60—  70 

1 780 

8 

69 

1953 

8 

9» 

2122 

9 

09 

2070 

8.52 

2126 

9.00 

2029 

8 

90 

70-  80 

1401 

7 

26 

1604 

7 

3« 

1975 

8 

45 

1 80b 

7-43 

1818 

7-69 

1766 

7 

78 

80-  90 

817 

3 

98 

830 

3 

91 

954 

4 

08 

944 

3-89 

893 

3-77 

801 

3 

53 

90-100 

11b 

5b 

158 

73 

133 

5° 

159 

-65 

144 

.61 

12^ 

54 

IOO-IIO 

6 

°3 

8 

03 

8 

°3 

5 

.02 

10 

.04 

b 

02 

110-120 

1 

The  high  infantile  mortality  is  due,  primarily,  to  the 
effects  of  faulty  nutrition,  owing  to  the  fact  that  so  many 
infants  must  be  nourished  by  means  of  artificial  foods. 
The  secondary  causes  of  the  high  infantile  mortality  are 
the  acute  catarrhal  inflammations  of  the  gastro-intestinal 
and  respiratory  tracts.  The  following  table  shows  the 
relative  frequency  of  the  diseases  of  the  type  of  acute 
catarrhal  inflammations  of  the  gastro-intestinal  and  re- 
spiratory tracts  as  compared  with  the  death-rate  from  the 
acute  infectious  diseases,  of  diseases  of  the  nervous  sys- 
tem, and  the  deaths  from  all  causes  in  children  under 
one  year  of  age,  in  Philadelphia  during  the  years  1890  to 
1894,  inclusive: 


Deaths  under  one  year  from — 

1890. 

1891. 

1892. 

1893. 

1894. 

Diseases  of  gastro-intestinal  tract   .    .    . 

5288 
2223 

767 

325 
940 

5488 

2479 

809 

303 
986 

5693 

2683 

882 

300 

908 

57IO 

2744 
856 
328 
916 

5472 
2694 

775 
325 
S43 

The  following  table  shows  the  total  number  of  deaths 


CA  USES  OF  DEA  TH.  2 1 

occurring  in  Philadelphia  during  1894,  the  number  of 
deaths  occurring  between  the  ages  of  twenty  and  sixty 
years,  and  the  principal  diseases  from  which  these  deaths 
have  occurred: 

Total  number  of  deaths,  all  ages 22,680 

All  causes,  twenty  to  sixty  years 7,778 

Tuberculosis,  twenty  to  sixty  years 2,014 

Inflammation  of  the  lungs 754 

Diseases  of  the  heart 650 

Cancer 340 

Casualties 333 

Bright's  disease 267 

Apoplexy 265 

Typhoid  fever 251 

Inflammation  of  kidneys 227 

Inflammation  of  peritoneum 210 

Inflammation  of  stomach  and  bowels 130 

Uremia 125 

Paralysis 1 17 

Suicide '       103 

The  principal  causes  of  death  in  persons  over  sixty 
years  of  age  are  shown  in  the  following  table,  as  indicated 
by  the  annual  reports  of  the  Bureau  of  Health  of  Phila- 
delphia for  the  years  1890  to  1894,  inclusive.  The  table 
also  shows  the  total  number  of  deaths  for  the  same  years, 
and  the  deaths  from  all  causes  for  persons  over  sixty  years 
of  aee. 


1893.     1894. 


Total  deaths,  all  ages    ....    .    .    . 

All  causes,  over  sixty  years 

Old  age  

Diseases  of  the  heart     .    .    .    .   ■     .    . 
Inflammation  of  the  lungs    .    .     •   .    . 

Apoplexy 

Paralysis 

Tuberculosis 

Cancer     

Bright's  disease      

Influenza     

Inflammation  of  bronchi 

Inflammation  of  stomach  and  bowels  . 

Inflammation  of  kidneys 

Debility 


22,732 

4,573 
816 
605 
398 
3H 
263 

234 
224 

165 

Si 

138 

102 

91 
no1 


23,367 
5,192 

736 
690 
568 
386 

302 

255 
201 

215 
174 
147 
120 
92 
104 


24,305 

4,984 

791 

639 

470 
410 
257 
232 
210 
202 
150 
154 
99 
94 
100 


23,655 

4,989 

796 

691 

465 

456 

243 

257 

262 

196 

62 

145 

138 

129 

40 


22,680 

4,725 
717 
588 
425 
439 
218 
240 
223 

183 
162 
136 
125 
178 
26 


22  INTRODUCTION. 

In  the  period  of  life  now  under  discussion,  the  period 
of  decline,  diseases  dependent  upon  degenerations  of  the 
tissues  and  organs  are  the  most  prevalent,  especially  dis- 
eases of  the  vascular  system,  and  it  is  probable  that  the 
causes  of  those  deaths  described  by  the  vague  terms  "  old 
age"  and  "debility"  are  usually  dependent  upon 
degenerations  of  this  character. 

2.  Sex. — The  influence  of  sex  as  a  predisposing  cause 
of  disease  does  not  manifest  itself  to  any  extent  until 
after  puberty,  and  again  becomes  less  marked  after  the 
age  of  forty-five  to  fifty  years.  Certain  diseases  are  far 
more  prevalent  in  women  than  in  men,  such  as  hysteria 
and  allied  nervous  diseases;  while  epilepsy,  locomotor 
ataxia,  gout,  and  acute  diseases  of  the  respiratory  tract 
are  more  prevalent  in  men  than  in  women.  Women 
have  a  greater  average  longevity  than  men,  because  they 
are  exposed  less  and  are  not  engaged  in  such  dangerous 
occupations. 

3.  Heredity. — Hereditary  influences  are  such  as  act 
from  within  the  body,  and  are,  therefore,  non-preventable. 
The  influence  of  heredity  is  shown  in  the  greater  prev- 
alence of  certain  diseases  in  one  family  than  another. 
This  difference  is  brought  about  by  certain  constitutional 
conditions  which  are  transmitted  from  generation  to 
generation,  and  consists  in  a  lessened  capability  of  resist- 
ing unfavorable  influences  upon  the  system.  This  con- 
dition was  believed,  until  recently,  to  be  actually  a  trans- 
mission of  disease,  as,  for  instance,  in  tuberculosis. 
Since  the  discovery  of  the  specific  micro-organisms  of  a 
number  of  diseases  the  theory  of  direct  transmission 
has  been  discarded  to  a  great  extent.  At  the  present  time 
it  is  believed,  however,  that  a  predisposition  to  develop 
tuberculosis  is  transmitted,  and  that  in  these  subjects  the 
disease  is  far  more  readily  developed  than  in  those  with- 
out such  hereditary  predisposition.  In  like  manner  the 
transmission  of  a  predisposition  to  develop  other  consti- 
tutional diseases  is  recognized  to-day,  such  as  carcinoma, 
gout,    rheumatism,   diabetes,   disease    of  the  circulatory 


CAUSES  OF  DISEASE.  23 

organs,  disease  of  the  nervous  system,  especially  insanity 
and  hysteria,  and  malformations. 

When  the  hereditary  influences  show  themselves  in 
the  same  sex  in  the  offspring  as  in  the  parent,  they  are 
said  to  be  homeomorphous,  and  when  they  show  them- 
selves in  the  opposite  sex  they  are  said  to  be  heteromor- 
phous. 

Hereditary  influences  are  intensified  by  the  intermar- 
riage of  near  relations,  because  these  influences  may  be 
present  in  both  parents. 

Connate  Conditions. — Connate  conditions  are  such  as 
are  born  into  a  person,  as  temperament,  idiosyncrasy, 
and  diathesis.  Temperament  refers  mainly  to  the  exter- 
nal appearance  of  the  person,  and  indicates  tendencies 
in  various  directions.  The  principal  temperaments  are 
the  sanguine,  the  lymphatic,  the  neurotic,  and  the 
melancholic  temperament.  Idiosyncrasy  has  reference 
to  special  liability  to  certain  affections,  as  hay  fever;  or 
peculiar  susceptibility  to  the  influence  of  certain  drugs, 
as  ipecac,  opium,  quinin,  etc.,  or  to  certain  articles  of 
diet,  as  shell-fish,  certain  berries,  etc.  Diathesis  has 
reference  to  special  tendencies  or  predisposition  to  certaiu 
diseases,  as  catarrhal  affections;  the  gouty  and  rheumatic 
diatheses,  etc. ;  and  indicates  a  weakness  in  a  particular 
part  of  the  body. 

The  late  Prof.  J.  G.  Richardson1  states  that  "persons 
of  a  sanguine  temperament  are  believed  to  be  especially 
liable  to  organic  diseases  of  the  heart,  to  aneurysms,  and  to 
the  bursting  of  blood-vessels  in  various  parts  of  the  body, 
so  that  they  should  especially  guard  against  articles  of 
food  and  habits  of  life  which  promote  the  formation  of 
an  excess  of  blood  in  the  system.  Individuals  of  lym- 
phatic temperament  seem  particularly  prone  to  scrofulous 
affections,  consumption,  dropsy,  and  skin  diseases.  Those 
of  bilious  temperament,  to  diseases  of  the  liver,  stomach, 
and  intestines;  and  those  of  nervous  temperament  to 
palsy,  St.   Vitus's  dance,  epileptic  fits,  etc." 

1  Long  Life,  and  Haw  to  Reach  It. 


24  INTRODUCTION. 

4.  Race. — The  influence  of  race  as  a  predisposing  cause 
of  disease  is  quite  marked  for  some  races.  The  Jews,  as 
shown  in  a  special  study  of  this  race  by  Dr.  John  S. 
Billings,  are  more  liable  to  diseases  of  the  nervous  system, 
especially  diseases  of  the  spinal  cord,  to  diarrheal  diseases, 
diphtheria,  diseases  of  the  circulatory  organs,  the  urinary 
system,  bones  and  joints,  and  diseases  of  the  skin.  They 
are  less  liable  to  tuberculosis  than  their  neighbors. 

Detailed  studies  of  the  vital  statistics  of  Boston,  New 
York  and  Brooklyn,  Philadelphia,  Baltimore,  and  Wash- 
ington for  the  six  years  ending  May  31,  1890,  by  Dr. 
Billings,  have  shown  that  the  death-rate  among  children 
of  Irish  mothers  is  greater  from  consumption,  pneu- 
monia, inanition,  debility,  atrophy,  heart  disease  and 
dropsy,  and  from  typhoid  fever,  than  among  children  of 
German  mothers,  while  the  death-rate  among  children  of 
German  mothers  is  markedly  greater  from  Bright' s  disease 
than  that  of  children  of  Irish  mothers.  A  large  part  of 
the  excessive  death-rate  among  children  of  Irish  mothers 
is  due  to  tubercular  diseases,  and  to  the  effects  of  alcohol, 
which  last  include  a  considerable  part  of  the  diseases  of 
the  nervous  system,  of  the  digestive  tract,  and  of  the 
urinary  organs  among  adults.  Cancer,  tumor,  and 
suicides  are  more  frequent  among  those  of  German 
parentage. 

The  higher  death-rate  among  the  colored  race  was 
found  to  be  due  mainly  to  the  excessively  high  death- 
rate  among  children  of  that  race.  The  death-rate  from 
consumption,  pneumonia,  typhoid  fever,  diphtheria  and 
croup,  diarrheal  diseases  of  infants,  diseases  of  the  nerv- 
ous system,  and  heart  disease  and  dropsy,  was  found  to  be 
much  greater  among  the  colored  population  than  among 
whites.  The  negro  race  is  less  liable  to  yellow  fever  and 
to  malaria  than  the  white  race. 

5.  Conjugal  Condition. — The  influence  of  conjugal 
conditions  upon  death-rates  is  manifest  from  the  follow- 
ing studies  made  in  Baltimore  and  Washington  for  the 
Eleventh  Census  : 


CAUSES  OF  DISEASE. 


Death-rates. 


25 


Baltimore. 

Washington. 

Conjugal 
condition. 

White. 

Colored. 

White.                    Colored. 

Male. 

Female. 

Male. 

Female. 

Male. 

Female.      Male. 

Female. 

Single    .... 
Married     .    .    . 
Widowed .    .    . 

9.19 

8.98 
26.90 

6-53 

9.76 

I2.IO 

13-75 
13-49 
I2.02 

13.20 

16.31 
14.36 

IO.O7 

9.06 

40.17 

6.44 
9-56 

I3-65 

I9.98 
16.60 
50-5I 

I4.50 
16.70 
15.12 

The  lower  death-rate  among  the  married  than  among 
either  single  or  widowed  is  probably  dne  to  the  better 
home  care  these  individuals  have,  and  also  to  the  fact 
that  they  lead  more  regular  lives.  The  extremely  high 
death-rate  among  widowed  males  is,  no  doubt,  traceable 
to  the  influences  exerted  by  the  destruction  of  the  home 
and  the  effects  entailed  by  this  loss.  Of  course,  the  age 
factor  also  exerts  an  important  influence  upon  these 
individuals. 

6.  Hygienic  Conditions  of  Environment. — The  influ- 
ence of  overcrowding  and  general  unhealthy  surround- 
ings, along  with  privation  and  want,  are  most  important 
as  predisposing  causes  of  disease.  It  is  somewht  difficult 
to  obtain  statistical  evidence  of  the  unfavorable  influence 
upon  health  of  the  general  hygienic  conditions  of  the  sur- 
roundings, yet  the  following  table,  based  upon  the 
special  Census  Report  for  Philadelphia  in  1890,  shows 
this  effect  fairly  well,  especially  with  regard  to  the  death- 
rate  from  consumption.  It  will  be  seen  that,  in  general, 
in  those  wards  in  which  the  number  of  persons  to  a 
dwelling  and  the  number  of  families  to  a  dwelling  are 
greater  than  the  average  for  the  entire  city  the  death- 
rate  from  consumption  is  also  above  the  average,  and  that, 
in  general,  in  those  wards  in  which  the  number  of  per- 
sons to  a  dwelling  and  the  number  of  families  to  a  dwell- 
ing are  below  the  average  the  death-rate  from  consump- 
tion is  also  below  the  average  for  the  entire  city. 

Aside  from  the  influence  of  overcrowding,  there  are 
other  conditions  of  environment  that  may  be  classed  as 
predisposing  causes  of  disease.     The  most  prominent  of 


26 


INTRODUCTION. 


Philadelphia,  18  go.      Census 

Report. 

Persons  to 

Q 

Death-rate 

Number  of 

per  1000 
POP- 

Death-rate  per 
100,000  pop. 

families  to 
dwelling. 

Population. 

< 

Dwelling. 

Acre. 

All  causes. 

Consumption. 

Acres. 

5 

7-48 

88.94 

25,67 

498.02 

1-43 

16,987 

205 

6 

6.8l 

44.68 

24.30 

418.46 

1 

38 

8,712 

205 

ii 

6.71 

95-95 

28.31 

330.86 

1 

3& 

12,953 

135 

4 

6-53 

141.56 

29.98 

44I. II 

1 

24 

20,384 

147 

9 

6-45 

33-25 

25.IO 

364.04 

1 

10 

9.791 

256 

8 

6.41 

61.27 

24.26 

332-28 

1 

oS 

16,971 

278 

7 

6-35 

110.14 

24.30 

408.9I 

1 

20 

30,179 

28l 

IO 

6-33 

98.69 

19.88 

278.12 

1 

07 

21,514 

230 

27 

6.30 

4-5i 

31-91 

504.81 

1 

05 

32,905 

1 7,475 

3 

6.19 

164.67 

23.9I 

3*3-33 

1 

23 

19,925 

122 

15 

6.09 

99.82 

20.08 

288.71 

1 

10 

52,705 

671 

12 

6.08 

114.27 

21-57 

314.16 

1 

21 

14,170 

124 

2 

6.06 

115.62 

23-93 

3l6-35 

1 

23 

31,563 

283 

13 

S-90 

109.96 

20.67 

260.98 

1 

16 

17,923 

163 

17 

5-82 

122-93 

28.89 

355-83 

1 

19 

19,546 

161 

34 

5.66 

( Includ 

ed  in  24th 

ward). 

1 

04 

14 

5-61 

I36-43 

21.47 

320.62 

1 

11 

20,737 

152 

16 

5.60 

94-93 

28.04 

311. 21 

1 

21 

17,087 

180 

29 

5-56 

87.20 

20.19 

293.26 

1 

06 

54,759 

896 

20 

5-55 

94.84 

20.77 

3°3I4 

1 

14 

44,480 

469 

30 

5-55 

92.21 

22.12 

349-35 

1 

09 

30,614 

332 

19 

546 

126.53 

23-73 

310.44 

1 

11 

55,545 

447 

24 

5-41 

14.07 

17-95 

269.24 

1 

05 

66,277 

6,224 

22 

5-40 

3.68 

17.77 

241.27 

1 

03 

45,329 

12,738 

21 

5-35 

6.44 

19-45 

242.86 

1 

05 

26,900 

4,563 

26 

5-32 

13.18 

19.48 

238.37 

1 

o5 

62,138 

4,788 

25- 

5-25 

14.41 

24.29 

271-55 

1 

06 

35,945 

2,641 

33 

5-23 

12.23 

13.07 

143-47 

1 

06 

33,i7i 

2,844 

3i 

5-17 

7231 

21.46 

284.92 

1 

03 

32,974 

456 

18 

5.16 

71-83 

24.42 

3°4-57 

1 

09 

29,164 

416 

1 

S-i5 

15-34 

22.08 

275-54 

1 

05 

53,882 

3,526 

28 

5-15 

14.62 

I5-56 

I85-73 

1 

05 

46,390 

3,542 

23 

5.06 

1.30 

18.50 

219.39 

1 

02 

35,294 

27,339 

32 

5-04 

118.77 

14.61 

192.32 

1 

03 

30,050 

5i8 

City 

5.60 

I3-32 

21.54 

297.87 

1 

10 

1,046,964 

82,807 

these  factors  are  the  nature  of  the  water-supply  and  the 
character  of  the  drainage.  The  relation  of  these  factors 
to  the  public  health  will  be  considered  in  detail  in  special 
chapters.  Dampness  of  the  soil  of  a  locality  is  also  an 
important  factor,  and  its  influence  in  relation  to  con- 
sumption has  been  carefully  investigated  by  Dr.  Bow- 
ditch,  of  Boston,  and  Dr.   Buchanan,  of  London.     Their 

1  Hospital  and  Almshouse. 


HYGIENE.  27 

investigations  have  shown  that  the  death-rate  from  con- 
sumption is  in  proportion  to  the  dampness  of  the  soil. 
Dampness  of  soil  is  also  an  important  predisposing  factor 
in  the  production  of  many  other  diseases,  such  as  mala- 
ria, rheumatism,  and  catarrhal  affections. 

The  influence  of  the  nature  of  the  occupation,  and  of 
the  climate  of  a  locality,  as  predisposing  factors  of  dis- 
ease will  be  discussed  in  detail  in  special  chapters  on 
these  subjects. 

Sanitary  science  refers  to  the  investigation  of  the 
causes  of  disease  and  the  means  of  avoiding  or  destroying 
them.  It  is  not  a  specific  department  or  separate  branch 
of  science,  but  is  implied,  in  part,  in  a  number  of 
sciences,  as  chemistry,  biology,  physics,  pathology,  statis- 
tics, etc. 

The  term  sanitary  means  conducive  to  the  preservation 
of,  and  the  term  sanitory  conducive  to  the  restoration  of, 
health.  The  sanitary  condition  of  a  place  has  reference 
to  the  presence  or  absence  of  the  specific  causes  of  disease. 
There  is  no  such  thing  as  bad  hygiene:  A  place  is  either 
in  hygienic  condition  or  it  is  in  an  unhealthful  condition. 

Hygiene  aims  to  discover  the  causes  of  all  diseases 
known,  and  the  best  means  of  removing  those  causes  or 
rendering  them  inoperative.  It  takes  for  granted  a 
knowledge  of  the  normal  functions  of  the  human  organ- 
ism, and  seeks  to  discover  the  reasons  for  perverted 
action  of  a  part  or  the  whole  of  the  organism.  It  involves 
a  thorough  knowledge  of  the  normal  conditions  of  man's 
environment  as  well  as  the  various  factors  which  tend  to 
render  that  environment  abnormal.  It  demands  a 
thorough  knowledge  of  the  chemical  and  physical  charac- 
ter of  man's  food-supply  and  those  changes  to  which  it  is 
liable  that  tend  to  injure  his  health  and  produce  disease. 
It  aims  to  keep  persons  in  perfect  health,  to  train  men  to 
be  strong  both  mentally  and  physically.  It  also  involves 
a  knowledge  of  the  physical  and  geological  nature  of  the 
surface  of  the  earth,  and  the  manner  in  which  these  con- 
ditions, in  different  localities,  influence  the  healthfulness 


28  INTRODUCTION. 

of  human  habitations.  It  comprises  a  knowledge  of  all 
the  various  human  ocupations,  and  the  manner  in  which 
these  may  be  conducted  so  as  to  be  free  from  danger  to 
health  or  how  to  render  them  least  objectionable. 

Hygiene  may  be  subdivided  into  several  departments 
relating  to  the  scope  of  its  application,  as  public  or 
general,  military,  naval,  personal,  municipal,  school, 
and  industrial  hygiene.  Public  hygiene  takes  cogni- 
zance of  factors  which  affect  the  general  public,  such  as 
nuisances  of  different  kinds:  Foul  odors,  noxious  gases 
or  dust  evolved  in  certain  manufacturing  processes,  and 
loud  noises.  Nuisances  are  generally  such  conditions 
which  aggravate  existing  disease  rather  than  produce 
disease.  Military,  naval,  personal,  school,  and  indus- 
trial hygiene  will  be  treated  more  or  less  generally 
in  special  chapters.  Municipal  hygiene  has  reference 
to  those  conditions  which  affect  the  general  health  of 
a  community  that  fall  directly  under  the  control  of 
municipal  governments,  such  as  the  influence  of  impure 
water-supplies  and  imperfect  drainage  upon  the  general 
health;  the  influence  of  overcrowding  in  the  habita- 
tions of  the  poor;  the  cleansing  of  city  streets  and  the 
removal  and  satisfactory  disposal  of  refuse  matters  ;  the 
regulation  of  the  isolation  and  care  of  those  affected  with 
infectious  diseases,  and  the  proper  disposal  of  the  dead. 

Development  of  Hygiene. — Modern  hygiene  has  been 
gradually  evolved  out  of  the  observations  and  discoveries 
of  many  men  prominent  in  philanthropic  work,  in  medi- 
cine, and  in  science.  Among  the  prominent  observations 
and  discoveries  made  during  the  eighteenth  century 
which  have  been  most  instrumental  in  the  development 
of  hygiene  may  be  mentioned  the  discovery  of  Sir 
George  Baker  with  regard  to  the  production  of  lead- 
poisoning  by  cider  stored  in  leaden  vessels;  the  observa- 
tions of  John  Howard  with  regard  to  the  baneful  influence 
of  foul  air  and  overcrowding  and  unhealthfulness  of  the 
surroundings  upon  the  health  of  the  occupants  of  prisons, 
poor-houses,  and  other  habitations,  and  their  relation  to 


HYGIENE.  29 

typhus  fever  ;  the  demonstration  by  Captain  James  Cook, 
in  his  voyage  around  the  world,  that  scurvy  was  a  pre- 
ventable disease  which  was  due  to  the  nature  of  the  diet; 
and  Sir  Edward  Jenner's  discovery  of  inoculation  as  a 
preventative  of  small-pox.  During  the  nineteenth  cen- 
tury the  movements  and  discoveries  which  stand  out 
most  prominently  are  the  work  of  Dr.  Thomas  South- 
wood  Smith  and  The  Sanitary  Committee  in  demonstrat- 
ing the  factors  which  are  instrumental  in  influencing 
the  health  of  towns,  such  as  the  accumulation  of  filth 
about  premises,  absence  of  sewers,  and  consequently 
the  pollution  of  water-supplies,  and  the  influence  of  in- 
sufficient air-supply  and  overcrowding  upon  the  general 
health ;  the  labors  of  Edwin  Chadwick  in  organizing  the 
first  board  of  health  in  England;  the  work  of  Dr.  William 
Farr,  Registrar-General  of  England,  in  securing  the  regis- 
tration of  the  cause  of  death  in  the  health  reports;  the 
labors  of  Dr.  E.  A.  Parkes  in  demonstrating  the  evil  effects 
of  defective  drainage  and  the  accumulation  of  filth  upon 
the  public  health,  and  in  securing  the  passage  of  various 
sanitary  acts  from  1848  to  1857;  the  work  of  Dr.  John 
Simon,  of  London,  and  his  able  staff  of  medical  inspec- 
tors with  regard  to  the  material  causes  of  disease,  and  the 
legislation  which  was  based  upon  these  investigations;  the 
studies  of  Dr.  C.  A.  Louis,  of  Paris,  upon  typhoid,  typhus, 
and  relapsing  fevers,  and  the  differentiation  between  these, 
as  well  as  similar  studies  made  at  the  same  time  by  Dr. 
William  W.  Gerhard,  of  Philadelphia;  the  studies  of  Dr. 
Henry  I.  Bowditch,  of  Boston,  and  those  of  Dr.  George 
Buchanan,  of  London,  upon  the  influence  of  dampness 
of  the  soil  upon  the  prevalence  of  consumption;  the 
studies  of  Louis  Pasteur  upon  the  causes  of  fermentation 
and  the  etiologic  relation  of  micro-organisms  to  disease, 
as  well  as  his  discoveries  with  regard  to  the  prevention 
and  treatment  of  these  diseases;  the  studies  of  Sir  Joseph 
Lister  with  regard  to  the  prevention  of  suppuration  in 
wounds,  which  have  been  the  starting-point  of  modern 
antiseptic  and  aseptic  surgery;  the  work  of  von  Petten- 


3o  INTRODUCTION. 

kofer  in  introducing  new  methods  of  chemical  research 
upon  air,  water,  and  food,  and  his  studies  upon  the  in- 
fluence of  soil-moisture  upon  the  prevalence  of  typhoid 
fever  and  cholera;  and  the  discoveries  of  Dr.  Robert 
Koch,  of  Berlin,  of  the  specific  micro-organisms  of  some 
of  the  infectious  diseases,  and  in  perfecting  methods  of 
bacteriologic  research. 


CHAPTER    I. 
AIR. 

Nature  and  Composition  of  the   Atmosphere. — 

Atmospheric  air  consists  of  a  mechanical  mixture  of 
gases,  the  relative  proportions  of  which  are  fairly  con- 
stant in  all  parts  of  the  world.  It  is  colorless,  odorless, 
transparent,  and  is,  therefore,  invisible  and  imperceptible 
when  quiescent.  It  is  only  when  it  is  itself  in  a  state  of 
motion,  or  when  our  bodies  are  in  rapid  motion,  that  we 
note  its  presence  through  the  resistance  which  it  mani- 
fests. It  also  possesses  weight,  and  consequently  exerts 
pressure.  At  the  sea-level,  when  the  temperature  is 
o°  C,  the  normal  pressure  of  the  atmosphere  is  sufficient 
to  support  a  column  of  mercury  760  millimeters  in  height, 
and  amounts  to  1033  grams  on  every  square  centimeter 
of  surface.  The  pressure  of  the  atmosphere  decreases  as 
we  rise  above  the  level  of  the  sea,  and  increases  as  we 
descend  below  its  level. 

The  several  gases  composing  the  atmosphere  are  not 
in  chemical  combination  with  each  other,  but  exist  as  a 
more  or  less  homogeneous  mixture.  The  principal  gases 
in  the  mixture  are:  Nitrogen  in  the  proportion  of  78.20 
parts,  by  volume;  oxygen,  20.76  parts;  argon,  1  part; 
carbon  dioxid,  0.04  part;  a  trace  of  ammonia;  traces  of 
nitrous  and  nitric  acids;  small  amounts  of  ozone;  vary- 
ing proportions  of  aqueous  vapor;  and  traces  of  several 
recently  discovered  constituents:  neon,  erythron,  and 
krypton. 

The  proportion  of  nitrogen  in  natural  air  varies  only 
within  extremely  narrow  limits.  It  is  an  indifferent  gas, 
and  seems  to  serve  principally  as  a  diluent  for  the  oxygen 
in  the  air.      So  far  as  known,  the  only  biologic  signifi- 

31 


32  AIR. 

cance  of  nitrogen  is  its  absorption  by  plants  of  the  order 
Leguminoscs  when  growing  in  symbiosis  with  certain 
micro-organisms  which  find  lodgement  on  the  roots  of 
these  plants,  and  where  they  cause  the  formation  of  the 
so-called  root-tubercles.  Argon,  neon,  erythron,  and 
krypton  are  likewise  inert  gases  so  far  as  known  at  the 
present  time. 

The  proportion  of  oxygen  in  the  air  varies  within 
somewhat  wider  limits  than  that  of  nitrogen,  but,  under 
natural  conditions,  it  is  fairly  constant,  because  any 
slight  decrease  in  its  proportion  in  circumscribed  locali- 
ties is  readily  corrected  through  the  action  of  the  princi- 
ple of  diffusion. 

The  proportion  of  carbon  dioxid  varies  usually  between 
0.03  and  0.05  part  per  100,  but  it  is  subject  to  still  greater 
fluctuations  at  different  elevations  above  the  earth's  sur- 
face, and  at  different  seasons  of  the  year.  The  propor- 
tion is,  generally,  greatest  at  the  surface  of  the  earth, 
and  decreases  as  the  elevation  increases.  It  is  least  in 
winter  and  greatest  in  autumn;  less  during  the  day  than 
at  night;  less  on  the  seacoast  than  inland;  and  less  on 
windy  days  than  on  calm  days.  It  is  decidedly  dimin- 
ished by  rain,  slightly  so  by  snow,  and  slightly  increased 
during  foggy  weather. 

The  relative  proportions  of  oxygen  and  carbon  dioxid 
are  maintained  through  the  combined  action  of  the  vege- 
table and  animal  world.  The  animal  kingdom  absorbs 
oxygen  and  gives  off  carbon  dioxid  in  return  as  the 
result  of  tissue  metabolism.  On  the  other  hand,  those 
members  of  the  vegetable  kingdom  which  possess 
chlorophyl  in  their  organism  have  the  property  of  ab- 
sorbing carbon  dioxid  from  the  air,  assimilating  the  car- 
bon and  giving  off  the  oxygen  in  return.  This  most 
interesting  cycle  is  an  important  factor  in  the  mainte- 
nance of  the  relative  proportions  of  these  two  gases  in 
the  air. 

The  proportion  of  aqueous  vapor  in  air  varies  with  the 
temperature — the  average  amount  being  about  1  per  cent. 


TEMPERA  TURE  OF  THE  AIR.  33 

The  amount  of  moisture  in  the  air  may  vary  from  less  than 
o.  1  per  cent,  to  as  much  as  4  per  cent.  The  higher  the 
temperature,  the  greater  the  amount  of  aqueous  vapor 
that  is  taken  up  by  air.  The  proportion  which  is  most 
agreeable  to  the  majority  of  persons,  and  therefore  the 
most  suitable  for  health,  is  about  75  per  cent,  of  satura- 
tion at  any  given  temperature. 

Ozone — condensed  or  allotropic  oxygen — is  present  in 
variable  amounts  in  different  places  on  the  earth's  sur- 
face. The  average  amount  present  is  1  milligram  per 
100  cubic  meters  of  air;  the  maximum  amount  being 
about  3.5  milligrams.  This  gas  is  usually  absent  from 
the  air  of  cities  and  the  air  which  has  passed  through 
localities  which  are  thickly  populated.  It  is  found  in 
the  atmosphere  over  fields  covered  with  vegetation,  over 
forests,  and  over  the  ocean.  Ozone  is  an  active  oxidizing 
agent,  and  the  air  of  cities  is  rich  in  oxidizable  organic 
matter  which  absorbs  it,  consequently  it  is  absent  from 
the  air  of  cities.  Generally  speaking,  the  healthiest  parts 
of  towns  are  those  receiving  the  purer  and  fresher  air, 
containing  ozone,  coming  from  cultivated  fields,  forests, 
or  the  ocean. 

The  amounts  of  ammonia,  nitrous  and  nitric  acids, 
found  in  ordinary  atmospheric  air  are  insufficient  to  have 
any  biologic  significance.  They  result  principally  from 
putrefaction  and  from  various  manufacturing  industries. 

The  atmosphere  forms  a  gaseous  envelope  which  sur- 
rounds the  earth,  reaching  a  height  of  from  320  to  350 
kilometers  above  the  earth's  surface,  and  penetrating 
into  the  porous  soil,  into  caves  and  mines,  and  into  the 
ocean  to  a  great  depth. 

Temperature  of  the  Air.— There  are  three  main  fac- 
tors that  influence  the  temperature  of  the  air  of  any 
place,  viz.,  latitude,  altitude,  and  the  relative  proximity 
of  large  bodies  of  water.  The  temperature  is  greatest 
near  the  equator  and  decreases  proportionately  with  the 
distance  traversed  in  passing  from  the  equator  to  the 
north  or  south  pole.  The  temperature  is  also  higher  at 
3 


34  AIR. 

the  level  of  the  sea  than  on  the  top  of  a  mountain  in  the 
same  latitude.  Places  near  the  seacoast  also  have  a  more 
equable  climate  than  those  in  the  interior.  The  other 
factors  which  influence  the  temperature  of  a  locality  are: 
The  conformation  of  the  earth's  surface;  the  nature  of 
the  soil;  the  character  and  extent  of  the  soil-covering; 
and  the  direction  of  the  prevailing  winds.  Owing  to  the 
high  specific  heat  of  water  (about  five  times  that  of  earth 
and  rocks)  the  ocean  absorbs  heat  slowly  and  gives  it 
off  slowly,  and,  therefore,  it  acts  as  a  reservoir  of  the 
heat,  absorbing  it  during  the  day  and  giving  it  off  during 
the  night,  also  absorbing  it  during  the  summer  and 
giving  it  off  during  the  winter,  thus  lessening  the  heat  of 
summer  as  well  as  the  cold  of  winter  for  places  along  the 
seacoast. 

Pressure  of  the  Atmosphere. — The  average  pressure 
of  the  atmosphere  varies  according  to  the  altitude  of  the 
locality,  and  also  in  the  same  locality  at  different  times. 
At  the  sea-level  this  average  pressure  amounts  to  a  little 
over  a  kilogram  per  square  centimeter,  and  is  sufficient  to 
support  a  column  of  mercury  760  millimeters  in  height; 
hence  the  total  weight  supported  by  an  average  man  is 
about  18,000  kilograms,  This  weight  or  pressure  is  con- 
siderable, but  it  is  unnoticed  because  it  is  equalized  by  the 
internal  pressure  of  our  bodies,  which  adapt  themselves 
to  the  normal  fluctuations  in  the  atmospheric  pressure. 
Variations  in  the  atmospheric  pressure  are  measured  by 
means  of  barometers.  The  mercurial  barometer  is  usually 
employed  in  making  these  observations  (Fig.  1).  Marked 
deviations  from  the  normal  atmospheric  pressure,  such  as 
are  found  in  exceedinglv  high  altitudes,  in  balloon  ascen- 
sions  to  great  heights,  or  when  descending  to  great  depths 
in  mines,  or  working  in  tunnels,  are  manifested  by  effects 
which  are  referable  to  the  increased  or  decreased  tension 
of  the  atmosphere.  Rarefied  air  as  found  at  great  heights 
induces  a  condition  known  as  mountain  sickness  or  bal- 
loon sickness,  and  consists  in  increased  heart  action, 
more   rapid    respiration,    headache,    followed    by   graver 


PRESSURE  OF  THE  A  TMOSPHERE. 


35 


symptoms  as  the  rarefaction  increases,  such 
as  vomiting  of  food,  bile,  and  blood,  with 
great  pain  in  the  stomach,  followed  by 
death.  There  are  frequently  minute 
hemorrhages  into  the  spinal  cord  as  the 
result  of  inspiring  rarefied  air.  The  in- 
sufficient supply  of  oxygen  in  the  rarefied 
air  is  perhaps  the  principal  cause  of  the 
symptoms  manifested. 

The  effects  of  passing  from  the  normal 
atmospheric  pressure  to  a  greater  pressure, 
as  in  diving-bells,  in  tunnels  under  rivers, 
are  different  from  those  seen  on  ascending 
to  a  great  height,  and  here  the  effects  are 
due  to  the  increased  pressure  upon  the 
body.  Every  10  meters  of  water  adds 
the  pressure  of  i  atmosphere — i  kilogram 
per  square  centimeter  of  body  surface. 
The  increased  pressure  causes  the  sudden 
liberation  of  gases  in  the  tissues  and 
blood,  where  they  interfere  with  the  cir- 
culation and  stop  the  heart.  The  differ- 
ence in  pressure  on  the  tympanic  cavity 
causes  vertigo  and  pain  in  the  ear,  and  if 
the  difference  in  pressure  is  great  the  drum 
of  the  ear  may  be  ruptured  when  the  Eus- 
tachian tube  is  occluded.  Ordinarily  the 
difference  in  pressure  is  equalized  by  the 
act  of  swallowing.  On  coming  out  of  a 
caisson  the  reverse  in  internal  and  exter- 
nal pressure  takes  place.  This  is  also  re- 
lieved in  the  same  manner.  Man  can  work 
at  a  kilometer  below  the  sea-level  without 
injury,  and  he  can  travel  to  a  height  of  5 
or  6  kilometers  without  being  affected  by 

Fig.  1.  —  Mercurial  barometer:  a,  cistern  containing  the  mercury;  b,  screw 
in  movable  bottom  of  cistern,  to  raise  or  lower  the  mercury  to  the  "  fiducial " 
point;  c,  the  vernier;  d,  the  thermometer. 


36  AIR. 

the  decrease  of  pressure.  When  the  pressure  is  suddenly 
increased  or  decreased  beyond  these  points  the  effects  are 
manifested.  The  more  slowly  the  change  is  brought 
about,  and  the  smaller  the  amount  of  exertion  accom- 
panying the  change  of  pressure,  the  less  the  effect 
produced.  Great  variations  from  the  normal  atmos- 
pheric pressure  are  highly  injurious  to  all  persons  suf- 
fering from  organic  disease  of  the  heart  and  lungs,  and 
to  those  suffering  from  an  atheromatous  condition  of  the 
arteries,  because  this  condition  prevents  the  arteries  from 
readily  adjusting  themselves  to  the  altered  pressure,  thus 
leading  to  hemorrhages.  In  coming  out  of  the  caisson 
the  change  in  pressure  must  be  brought  about  slowly. 
The  too  rapid  change  induces  spinal  hemorrhage.  At 
least  six  to  ten  minutes  should  be  allowed  for  each 
additional  atmosphere  of  pressure  to  make  the  change 
safely.  The  air-locks,  where  the  change  of  pressure  is 
made,  should  be  at  the  top  of  the  shaft,  and  not  at  the 
bottom,  so  that  the  men  are  not  obliged  to  climb  the 
ladder  when  they  come  into  the  ordinary  pressure. 

Distribution  of  Atmospheric  Pressure. — The  ba- 
rometer is  high  (i)  when  the  air  is  very  cold,  for  then 
the  lower  strata  are  denser  and  more  contracted  than 
when  it  is  warm.  The  contraction  causes  the  upper 
layers  to  sink  down,  bringing  a  greater  number  of  air- 
particles — that  is,  a  greater  mass  of  air — into  the  column, 
so  that  the  pressure  at  its  base  is  greater;  (2)  when  the 
air  is  dry,  for  then  it  is  denser  than  when  it  is  moist; 
(3)  when  in  any  way  an  upper  current  sets  in  toward  a 
given  area,  for  this  compresses  the  strata  underneath. 

Conversely,  the  barometer  is  low  (1)  when  the  lower 
strata  are  heated,  causing  the  surfaces  of  equal  pressure 
to  rise,  and  the  upper  layers  to  slide  off,  for  by  this  means 
the  mass  of  air  pressing  on  the  area  below  is  reduced; 
(2)  when  the  air  is  damp,  for  as  the  density  of  aqueous 
vapor  at  o°  C.  temperature  and  760  millimeters  pressure 
is  0.7721,  air  being  1,  the  mixture  is  lighter  the  more 
vapor  it  contains,  and  consequently  damp  air  does  not 


HUMIDITY  OF  THE  A  TMOSPHERE. 


37 


press  as  heavily  as  dry  air  on  the  unit  of  area  below;  (3) 
when  the  air,  from  any  cause,  has  an  upward  movement, 
for  this,  of  course,  acts  in  the  same  manner  as  when  the 
lower  strata  are  heated. 

Humidity  of  the  Atmosphere;  Hygrometry. — 
Hygrometry  is  the  determination  of  the  amount  of 
aqueous  vapor    in    the    air.       Hygrometers    are    either 


FlG.  2. — Daniell's  hygrometer  :   a,  bulb  surrounded  with  cotton  cloth ;  b,  ther- 
mometer;  c,  bulb  containing  thermometer. 


direct,  as  Daniell's  (Fig.  2),  Dine's,  and  Regnault's, 
and  determine  directly  the  dew-point  of  the  atmosphere; 
or  indirect,  as  the  wet-  and  dry-bulb  thermometer,  or 
psychrometer  (Fig.  3),  and  the  hair  hygrometer  (Fig.  4). 
The  important  items  of  information  to  be  derived  from 
observations  with  hygrometers  are:  The  dew-point,  the 
vapor-tension  or  absolute  humidity,  and  the  relative  hu- 


38 


AIR. 


midity  of  the  atmosphere.  The  dew-point  is  that  tem- 
perature at  which  the  air  is  saturated  with  moisture,  so 
that  the  least  further  fall  in  temperature  causes  a  deposit 

of  moisture  in  the  form  of 
dew.  The  higher  the  tem- 
perature of  the  air,  the  larger 
the  amount  of  water  it  can 
contain  in  the  form  of  vapor; 
and  if  the  temperature  be  low- 
ered, the  amount  of  moisture 
remaining  the  same,  eventu- 
ally a  point  will  be  reached 
at  which  some  of  the  moist- 


FlG.    3. — Psychrometer  :     a,    dry-  FlG.   4. — The  hair  hygrometer  :    a, 

bulb  thermometer;    /;,  wet-bulb  ther-  b,    point    of    suspension    of    hair;      p, 

mometer;      c,     reservoir      containing  pointer;  c,  d,  scale;  w,  weight, 
water. 


ure  is  precipitated.  This  temperature  is  indicated 
directly  by  the  condensation  hygrometers,  or  it  can  be 
calculated  from  the  readings  of  the  psychrometer,  with 
the  aid  of  tables  or  by  means  of  Apjohn's  formula: 


ELASTIC  FORCE  OF  VAPOR.  39 

E  =  elastic  force  of  vapor  corresponding  to  the  dew-point, 

e  =  elastic  force  corresponding  to  temperature  of  evaporation  (wet-bulb  ther- 
mometer), 

t  =  dry-bulb  temperature, 
tl  =  wet-bulb  temperature,  and 
h  =-  height  of  barometer  in  millimeters. 

E  =  e  —  0.01147  (/— tl)  X  /^1^. 
3° 

For  pressures  of  about  760  millimeters,  -    —    may  be 
neglected,  and  the  formula  becomes 


E 


(t  —  fi) 


87 

For  temperatures  below  o°  C.  the  formula  is 
E  _    /  —  t1 

The  tension  (E)  of  the  aqueous  vapor  in  the  atmos- 
phere may  be  calculated  from  the  readings  of  the  wet- 
and  dry-bulb  thermometers  by  means  of  the  following 
empirical  formula: 

E  =  e1  —  0.00077  (t  —  tl)  x  h, 

in  which  el  is  the  maximum  tension  corresponding  to 
the  temperature  of  the  wet-bulb  thermometer  (Ganot). 

If  the  dew-point  is  known,  either  by  calculation  from 
the  readings  of  the  wet-  and  dry-bulb  thermometers,  or 
by  direct  observation  by  means  of  the  hygrometer,  the 
elastic  force  or  tension  of  vapor  present  in  the  atmos- 
phere is  found  immediately  by  reference  to  a  table  of 
tensions. 

Elastic  Force  of  Vapor. — This  is  the  amount  of 
barometric  pressure  due  to  the  vapor  present  in  the  air. 
The  tension  of  aqueous  vapor  at  ioo°  C.  temperature  is 
760  millimeters — that  is,  the  pressure  of  1  atmosphere. 
At  lower  temperatures  the  elastic  force  of  vapor  is  less 
than  at  ioo°  C.  It  is  greatest  within  the  tropics  and 
diminishes  toward  the  poles;  it  is  greatest  over  the 
ocean,  and  decreases  as  we  pass  inland;  it  is  greater  in 


40  AIR. 

summer  than  in  winter;  it  is  greater  at  midday  than  in 
the  morning;  and  it  generally  diminishes  with  increased 
elevation. 

Absolute  Humidity. — This  is  the  weight  of  water  in 
the  form  of  vapor  contained  in  a  given  volume  of  air  ex- 
pressed in  grams  per  cubic  meter.  It  varies  with  the 
temperature,  and  it  may  be  computed  from  the  readings 
of  the  wet-  and  dry-bulb  thermometers  by  the  use  of 
tables. 

Relative  Humidity. — Complete  saturation  of  the  air 
being  taken  as  ioo,  any  degree  of  dryness  may  be  ex- 
pressed in  percentage.  The  amount  of  aqueous  vapor 
actually  present,  and  the  amount  that  would  be  present 
if  the  air  were  saturated,  being  known,  the  former  is  ex- 
pressed as  a  percentage  of  the  latter,  giving  the  relative 
humidity.  Relative  humidity  is  greatest  near  the  surface 
of  the  earth  during  night,  when  the  temperature,  being 
at  or  near  the  daily  minimum,  reaches  the  dew-point  ;  it 
is  also  great  in  the  morning,  when  the  sun's  rays  have 
evaporated  the  dew,  and  the  vapor  is  as  yet  diffused  only 
a  little  way  upward ;  and  it  is  least  during  the  greatest 
heat  of  the  day. 

The  Influence  of  Humidity  on  Health. — The  amount 
of  relative  humidity  of  the  atmosphere,  or  its  comple- 
ment the  deficiency  of  saturation,  is  of  the  greatest  im- 
portance. The  temperature  of  the  body  is  regulated  by 
the  loss  of  heat  by  evaporation  from  the  lungs  and  skin. 
At  a  temperature  of  150  C,  and  with  the  relative  hu- 
midity at  75  per  cent.,  Pettenkofer  and  Voit  estimated 
the  loss  of  water  from  the  lungs  at  286  grams,  and  from 
the  skin  at  500  to  1700  grams  daily.  If  the  relative 
humidity  be  increased,  there  will  be  a  hindrance  to  the 
escape  of  water  from  the  body;  and  when  this  condition 
is  combined  with  a  high  temperature  the  heat  is  far  more 
oppressive  than  when  the  atmosphere  is  dry  and  allows 
free  evaporation.  On  the  other  hand,  a  moist,  cold 
atmosphere  is  far  more  distressing  than  when  the  air  is 
drv  and  there  is  but  little  movement. 


CLOUDS.  41 

Movements  of  the  Atmosphere. — The  air  is  in  con- 
stant motion  as  the  result  of  changes  in  temperature 
affecting  the  density  of  the  air  of  certain  localities,  the 
less  dense  or  heated  air  being  displaced  by  the  colder, 
denser  air.  The  direction  in  which  the  movement  takes 
place  is  always  along  the  line  of  least  resistance  and 
toward  the  point  of  less  density.  The  rapidity  of  the 
movement  is  directly  proportional  to  the  magnitude  of 
the  change  in  density — that  is,  the  rise  in  temperature. 
The  most  important  cause  of  these  movements  is  the 
relatively  larger  amount  of  heat  transmitted  by  the  sun 
in  the  tropics,  which  gives  rise  to  what  are  known  as 
"trade"  winds.  The  varying  amounts  of  heat  trans- 
mitted by  the  sun  in  different  latitudes  and  at  different 
altitudes,  and  the  variations  in  the  temperature  due  to 
the  revolutions  of  the  earth  on  its  axis,  are  the  principal 
causes  of  winds.  These  movements  of  the  atmosphere 
play  an  important  part  in  the  regulation  of  temperature 
and  of  the  humidity  of  the  air.  If  they  did  not  occur, 
air  would  be  perpetually  warm  in  some  places  and  per- 
petually cold  in  others.  The  wind  carries  warm  air  to 
cold  regions  and  cold  air  to  warm  regions,  thus  tempering 
the  climate  of  each.  The  wind  also  prevents  the  air 
from  remaining  excessively  dry  in  some  regions  and  in- 
ordinately damp  in  others. 

The  effects  of  wind  upon  health  are  complex  and 
not  well  defined.  All  wind,  or  movement  of  the  air, 
favors  evaporation,  and  therefore  loss  of  heat  from  the 
body,  unless  the  wind  itself  be  warm  and  moist;  a  hot, 
dry  wind  favors  evaporation  but  does  not  lower  the  tem- 
perature; a  cold,  moist  wind  lowers  the  temperature  but 
does  not  increase  the  evaporation.  The  condition  of  the 
air  as  regards  humidity  influences  the  effect  of  the  wind. 
Winds  that  are  warm  and  moist  are  mild  and  relaxing; 
dry,  cool  winds  are  bracing;  but  cold  winds  are  penetrat- 
ing, and  are  considered  dangerous  to  persons  of  delicate 
constitution. 

Clouds. — When  the  condensed   moisture  of  the  air 


42  AIR. 

collects  as  fog  in  the  lower  strata  and  rises  into  the  upper 
strata  it  takes  the  form  and  appearance  which  we  call 
clouds.  Clouds  moderate  radiation,  both  solar  and  ter- 
restrial, and,  therefore,  have  an  equalizing  influence  on 
the  temperature.  Their  amount  is  estimated  from  o 
(clear  sky)  to  10  (entirely  overcast).  There  is  most  cloud 
in  winter,  in  the  middle  of  the  day,  and  least  in  May 
and  June,  during  the  night. 

Precipitation  of  Moisture. — The  amount  of  cloud- 
formation  bears  a  certain  relation  to  the  amount  of  pre- 
cipitation. According  to  the  temperature  of  the  air,  the 
precipitation  takes  place  in  the  form  of  rain,  snow,  hail, 
or  sleet.  The  amount  of  rainfall  in  a  locality  is  depend- 
ent to  a  certain  extent  upon  its  vicinity  to  large  bodies 
of  water,  upon  the  direction  of  the  prevailing  winds, 
upon  the  altitude,  and  upon  the  latitude.  The  nature 
and  extent  of  the  soil-covering  of  the  locality  also  have 
a  direct  influence  upon  the  amount  of  rainfall,  as  shown 
by  the  diminished  rainfall  in  localities  where  the  forests 
have  been  destroyed.  The  immediate  effect  of  a  fall  of 
rain  is  to  cleanse  and  purify  the  air  from  dust  of  all  sorts, 
organic  and  inorganic,  and  from  micro-organisms.  Its 
action  with  regard  to  the  micro-organisms  is  twofold:  It 
not  only  washes  them  out  of  the  air,  but  it  tends  to  pre- 
vent their  rising  from  the  soil  by  rendering  the  surface 
of  the  ground  moist.  So  far  the  influence  of  rain  is  de- 
cidedly beneficial  to  health;  but  when  rainfall  is  so  ex- 
cessive as  largely  to  increase  the  humidity  of  the  air,  its 
hygienic  effect  becomes  merged  in  that  of  humidity. 
Also,  when  the  amount  is  so  great  as  to  render  the  soil 
waterlogged  its  effect  becomes  overshadowed  by  the 
effects  of  a  damp  soil. 

Climate. — By  climate  we  understand  all  the  meteoro- 
logic  conditions  of  a  place  or  locality  which  have  an 
influence  upon  health.  Along  with  these  conditions  the 
character  of  the  soil  is  also  an  important  factor  in  de- 
termining and  regulating  the  nature  of  the  climate  of  a 
locality.      Of  all  these  conditions,  meteorologic  and  tel- 


CLIMA  TE.  43 

luric,  temperature  is  the  most  important  in  determining 
the  character  of  a  climate,  while  humidity  is  the  factor 
next  in  importance.  Buchan  states  that  there  are  four 
principal  factors  in  the  production  of  the  climate  of  any 
locality:  (i)  Distance  from  the  equator;  (2)  height  above 
the  sea-level;  (3)  distance  from  the  sea;  and  (4)  prevailing 
winds.  Of  the  various  classifications  of  climates  that 
have  been  proposed,  perhaps  as  satisfactory  as  any  is  one 
that  rests  mainly  upon  the  first  three  conditions  named, 
the  fourth  condition,  that  of  the  prevailing  winds,  intro- 
ducing important  modifications.  Of  all  the  factors,  dis- 
tance from  the  equator  is  incomparably  the  most  potent, 
but  irregularities  in  the  distribution  of  land  and  water, 
and  the  prevalence  of  particular  winds,  often  bring  about 
a  subversion  of  what  Humboldt  calls  the  solar  climate 
of  the  earth.  Differences  of  elevation  also  cause  ereat 
differences  in  the  climate  of  nearly  adjacent  places. 

Climates  may  be  divided  into  tropical,  temperate, 
and  polar;  and  the  first  two  of  these  may  be  subdivided 
into  continental,  maritime,  and  mountain  climates.  A 
continental  climate  is  subject  to  the  extremes  of  heat 
and  cold;  has  an  atmospheric  pressure  that  is  normal;  a 
moderate  rainfall;  slight  humidity;  often  a  clear  sky; 
and  variable  winds.  A  maritime  climate  is  equable — 
that  is,  without  extremes  of  temperature;  with  consider- 
able atmospheric  pressure;  considerable  humidity;  moder- 
ate rainfall;  a  misty  or  cloudy  sky;  winds  often  regular. 
A  mountain  climate  has  a  lower  temperature  and  less 
pressure  than  the  preceding;  considerable  rainfall;  large 
relative,  but  small  absolute,  humidity;  sky  often  clear, 
consequently  considerable  terrestrial  radiation  and  low 
night  temperature;  and  winds  determined  by  the  con- 
figuration of  the  earth's  surface. 

Some  idea  as  to  the  climatic  conditions  of  different 
localities  in  the  United  States  may  be  gained  by  refer- 
ence to  the  following  table,  showing  the  mean  and  ex- 
treme temperature,  and  the  mean  precipitation  of  these 
localities: 


44 


AIR. 


Normal  Temperature  and  Rainfall  in  the  United  States 

At  Weather  Bureau    Stations ;    also  Highest  and  Lowest   Temperatures   ever 

Reported  to  September  i,  i8gg. 


Stations. 

Temperature. 

nual 
:ion. 
and 
low. 

States  and 

Mean. 

Extreme. 

o-   13 

territories. 

'o.S  is 

Jan. 

July. 

High- 
est. 

Low- 
est. 

°C. 

°C. 

°c. 

°c. 

Cm. 

Alabama  .... 

f  Mobile  .... 
}  Montgomery   . 

IO.O 

■2-7-7 

38.3 

-18.3 

IS7-9 

8.8 

27.7  ■ 

41.6 

'—20.5 

133-7 

Arizona     .... 

Yuma 

12.2 

33-3 

47-7 

-5-5 

7.6 

f  Fort  Smith    .    . 
{  Little  Rock  .    . 

I.I 

26.6 

42.2 

—26.1 

II3-5 

Arkansas  .... 

4-4 

27-3 

4«-5 

— 22.2 

136,1 

f  Red  Bluff     .    . 

7-7 

27.7 

45-5 

-7-7 

66.2 

California.    .    .    . 

<  Sacramento  .    . 

7-7 

22.2 

43-3 

-8-3 

53-o 

(_  San  Diego    .    . 

12.2 

19.4 

38.3 

—0.0 

26.6 

Colorado  .... 

Denver 

-2.7 

22.2 

40-5 

-33-8 

36.3 

Connecticut.    .    . 

New  Haven  .    .    . 

-2.7 

22.2 

37-7 

-25-5 

127.7 

Delaware  .... 

Del.  Breakwater. 

-o-S 

22.7 

33-8 

—  17.2 

82.8 

Dist.  of  Columbia 

Washington      .    . 

-0.5 

25.0 

40.0 

—26.1 

110.4 

Florida      .... 

f  Jacksonville 
{  Key  West     .'   . 

12.7 

27.7 

40.0 

—12. 1 

137-3 

21. 1 

28.8 

37-7 

5-o 

97-7 

Georgia     .... 

[Atlanta.    .    .    . 
{  Savannah .    .    . 

6.1 
10.5 

25-5 
27.7 

37-7 
40-5 

—22.2 
-13-3 

132.0 
131-8 

Boise 

— 2.2 

23-3 

41.6 

-33-3 

33-5 

f  Chicago     .    .    . 

-3-3 

22.2 

37-7 

-30.5 

88.3 

{  Springfield    .    . 

-3-8 

25.0 

38.8 

—30.0 

96.5 

Indiana'    .... 

Indianapolis     .    . 

—2.2 

24.4 

38.3 

-3i-7 

109.2 

Indian  Territory- 

Fort  Sill    .... 

1-3 

27.7 

41.6 

—22.7 

79.2 

f  Des  Moines  .    . 
|  Keokuk     .    .    . 

-8-3 

23-7 

40.0 

-34-4 

84.0 

-5-o 

25.0 

40.0 

-3i-i 

90.4 

Kansas      .... 

Dodge 

-3-8 

25-5 

42.2 

-32.2 

50.2 

Kentucky.    .    .    . 

Louisville .... 

1.1 

26.1 

4°-S 

-28.8 

116.3 

Louisiana.    .    .    . 

f  New  Orleans    . 
{_  Shreveport    .    . 

12.2 

7-3 

28.3 
28.3 

37-3 
41.6 

-13-9 

-20.5 

153-6 
123.4 

Maine    ..... 

|  Eastport    .    .    . 
{  Portland   .    .    . 

-5-o 

15-5 

32-7 

-29.4 

114.8 

-6.6 

20.7 

36.1 

-27-3 

107.4 

Massachusetts .    . 

Boston 

-3-3 

21.6 

38.3 

-25.0 

II4-3 

Michigan  .... 

f  Marquette     .    . 
{  Port  Huron  .    . 

-8.8 
-6.1 

18.3 
20.7 

37-7 
37-3 

-32.7 
-3i-7 

82.2 

80.2 

Minnesota    .    .    . 

f  Duluth  .... 
|  St.  Paul     .    .    . 

—12.2 
—11 -7 

18.8 
22.2 

37-3 
37-7 

-41.7 
-41.7 

78.7 
69.8 

Mississippi    .    .    . 

Vicksburg     .    .    . 

8-3 

27.7 

38.3 

-18.3 

141-4 

Missouri   .... 

f  St.  Louis  .    .    . 
j  Springfield    .    . 

—1.1 

0.0 

26.1 
23-7 

41. 1 

38.8 

-30.5 
-33-8 

104.3 
116. 0 

Montana  .... 

Havre 

-12.7 

19.4 

42.2 

-48.3 

35-8 

Nebraska 

f  Omaha  .... 
1  Valentine  .    .    . 

-7-3 

24.4 

41.1 

-35-5 

80.5 

— 10.0 

23-3 

41. 1 

-38.8 

48.5 

Nevada 

Winnemucca   .    . 

—2.2 

22.2 

40.0 

-33-3 

21.5 

North  Carolina    . 

f  Hatteras    .    .    . 
|  Wilmington  .    . 

6.6 
8-3 

25-5 
26.6 

33-3 
39-4 

-13-3 
-15.0 

168.6 
137.8 

North  Dakota      . 

/  Bismark     .    .    . 
\  Williston  .    .    . 

-I5-S 
-16.1 

19.4 
20.0 

40-5 
41.6 

—42.2 
-45-0 

46.7 
35-5 

New  Hampshire 

Manchester  .    .    . 

-5-5 

20.7 

35-5 

-23-9 

106.4 

New  Jersey  .    .    . 

f  Cape  May     .    . 
j  New  Brunswick 

1.1 
—2.2 

23-3 
23-3 

32-7 
37-7 

-19.4 
-23-3 

119.8 
118. 8 

New  Mexico     .    . 

Sante  Fe   .    .    .    . 

—2.2 

20.0 

36.1 

-25.0 

40-5 

( Albany      .    .    . 

-5-o 

22.7 

37-7 

-27.7 

96.2 

New  York     .    .    . 

■j  New  York     .     • 

—1.1 

23-3 

37-7 

—21. 1 

II3-7 

( Oswego     .    .    . 

-3-8 

20.7 

37-7 

-3°-5 

88.9 

CLIMA  TE. 


45 


States  and 
territories. 


Ohio 


Oregon 


Pennsylvania 

Rhode  Island 
South  Carolina 
South  Dakota 

Tennessee    . 


Texas    .    . 

Utah  .    .    . 
Vermont   . 

Virginia    . 


Washington . 
West  Virginia 
Wisconsin    . 
Wyoming     . 


Stations. 


f  Cincinnati 
(  Toledo  . 
J  Portland 
{  Roseburg 
J  Philadelph 
{  Pittsburg 

Newport    . 

Charleston 

Yankton    . 
f  Memphis 
{  Nashville 
J  El  Paso 
{  Palestine 

Salt  Lake  . 

Burlington 
f Lynchburg 
{  Norfolk . 
J  Dayton  . 
{  Olympia 

Morgantown 
f  La  Crosse 
{  Milwaukee 

Cheyenne 


Temperature. 

Mean. 

Extreme. 

Jan. 

July. 

High- 
est. 

Low- 
est. 

°C. 

°.C. 

°c. 

°C. 

-0.5 

25-5 

40.0 

-27-3 

-3-3 

22.7 

37,3 

-26.6 

3-8 

19.4 

38.8 

-18.8 

4.4 

18.8 

40.0 

—21. 1 

0.0 

24.4 

38.8 

—21. 1 

—1.1 

22.7 

39-4 

-28.8 

—1.1 

21. 1 

33-3 

—22.2 

9-4 

27.7 

40.0 

-13-9 

-10.5 

22.7 

39-4 

-36.6 

4-4 

27-3 

38.8 

—22.7 

3-3 

26.6 

40.0 

—25.0 

6.6 

27.7 

45  -° 

—20.5 

6.1 

27.7 

40.0 

—21. 1 

—2.2 

24.4 

38.8 

-28.8 

-7.2 

21.6 

36.1 

-3i-7 

2.2 

25-5 

38.8 

—21. 1 

4-4 

26.1 

38.8 

-16.6 

—1.1 

20.0 

42.7 

—32.2 

3-3 

16.6 

36.1 

-18.8 

1.6 

23-3 

36.1 

-3!-7 

-9.4 

22.7 

38.3 

-41. 6 

-7.2 

20.7 

37-7 

-3J-7 

-3-8 

19.4 

37-7 

-38.8 

=   4>'s   41 

8  pjA  6 


Cm. 
101.3 

78.4 
118.8 

89.4 
IOI.2 

93-2 
127.0 

143-9 
68.0 

135-3 

127.2 

23.6 

118. 1 

41. 1 

72.2 

108.6 

I32-3 

70.5 

134.8 

119. 1 

77-9 

8i,S 

30-9 


Note. — The  minus  ( 


indicates  temperature  below  o  °  C. 


The  Influence  of  Climate  on  Health. — In  warm 
climates  the  functions  of  the  liver  and  skin  are  particu- 
larly active;  the  digestion  is  not  vigorous,  though  the 
activity  of  intestinal  peristalsis  is  often  great;  the  ner- 
vous system  is  excited  or  depressed  according  to  the 
degree  of  humidity  of  the  air.  In  cold  climates  the 
digestive  functions  are  vigorous;  the  nervous  system 
sluggish;  muscular  development  large;  and  life  generally 
prolonged  in  spite  of  the  severity  of  the  climate.  In 
temperate  climates,  which  on  the  whole  are  the  healthiest, 
there  is  no  great  strain  on  the  liver,  digestive  organs,  and 
skin  as  in  hot,  nor  on  the  lungs  and  kidneys  as  in  cold 
and  damp  climates. 

A  climate  with  o  to  50  per  cent,  relative  humidity  is 
unusually  dry,  with  50  to  70  per  cent,  relative  humidity 
is  dry,  with  70  to  85  per  cent,  relative  humidity  is  moist, 
and  with  85   to  100  per  cent,  relative  humidity  is  un- 


46  AIR. 

usually  moist.  The  character  of  a  climate  is,  however, 
also  influenced  by  the  temperature  as  well  as  the  relative 
humidity.  At  low  temperatures,  but  more  especially 
at  high  temperatures,  the  relative  humidity  of  the  atmos- 
phere plays  a  most  important  role  in  determining  the 
healthfulness  of  the  climate  of  a  locality. 

The  influence  of  climate  upon  the  course  of  certain 
diseases  has  been  the  subject  of  numerous  observations. 
The  influence  of  a  dry  climate  upon  the  course  of  tuber- 
culosis is  now  well  understood.  The  rarefied  air  as  found 
in  the  Rocky  Mountain  region  seems  to  be  of  great  value 
in  the  treatment  of  this  disease.  This  condition  of  the 
atmosphere  produces  an  augmented  respiratory  activity 
which  is  highly  beneficial  in  early  stages  of  consump- 
tion. 

The  value  of  pine  forests  in  localities  having  a  dry, 
sandy  soil  and  a  climate  of  low  relative  humidity  is  also 
generally  recognized.  The  pine  belts  of  New  York, 
New  Jersey,  and  North  Carolina  are  especially  adapted 
for  consumptives  during  the  winter  months  of  the  year. 

Probably  the  chief  value  of  removal  to  another  climate 
in  the  early  stages  of  consumption  is  to  be  traced  to  the 
changed  conditions  of  life.  The  outdoor  life  which  these 
localities  usually  permit,  along  with  the  high  percentage 
of  clear  days,  and  the  removal  from  the  anxieties  and 
constraints  of  business  life,  are  as  beneficial  as  the  climate 
itself,  if  not  more  so.  The  conviction  that  this  is  the 
case  has  led  a  number  of  prominent  physicians  to  advo- 
cate the  high  plateaus  of  the  Blue  Mountains  in  eastern 
Pennsylvania  as  a  desirable  locality  for  the  recuperation 
of  those  likely  to  be  benefited  by  change  of  climate.  The 
locations  which  have  been  specially  advocated  are  Pocono 
Mountain  in  Monroe  County  and  Green  Mountain  in 
Lehigh  County.  This  region  is  the  natural  home  of  the 
pine,  though  the  operations  of  the  lumbermen  have  long 
since  caused  its  almost  total  disappearance.  The  State 
of  Pennsylvania  is  acquiring  a  number  of  large  areas  of 
land  in  different  parts  of  the  State  for  forest  reservations, 


INFLUENCE  OF  CLIMATE  ON  MORTALITY.      47 

and  in  time  these  will  be  valuable  localities  for  the  estab- 
lishment of  institutions  for  the  climatic  treatment  of  dis- 
eases similar  to  those  found  in  the  Adirondack  region  of 
New  York  and  elsewhere. 

Influence  of  Climate  and  Season  on  Mortality. — 
The  seasonal  variations  alone  in  the  temperate  zone  are 
of  great  influence  upon  mortality  aside  from  the  general 
climatic  conditions  of  a  locality.  Mild  winters  and  cool 
summers  both  lower  the  mortality,  the  former  exerting  a 
special  influence  upon  the  aged,  and  the  latter  upon  the 
young,  more  particularly  the  infantile  population.  A 
cool,  damp  summer  is  always  accompanied  by  a  low  mor- 
tality. Season  has  also  an  important  influence  upon  the 
character  of  the  prevalent  diseases — intestinal  diseases 
being  most  prevalent  in  summer  and  respiratory  diseases 
in  winter.  Typhoid  fever  is  least  prevalent  in  late  spring 
and  early  summer,  and  most  prevalent  in  the  autumn. 
Typhoid  fever  reaches  its  mean  about  the  end  of  the 
year;  then  there  occurs  a  gradual  fall  to  a  minimum  in 
April,  sometimes  interrupted  by  a  slight  outbreak  in 
January  or  February.  There  is  also  a  June  or  July  mini- 
mum with  a  more  rapid  rise  to  maximum  about  the  end 
of  October-  or  beginning  of  November.  The  curve  of 
scarlet  fever  is  very  similar  to  that  of  typhoid  fever,  but 
its  minimum  is  in  March,  and  it  rises  gradually  to  a 
maximum  early  in  November. 

Acclimatization  is  that  process  by  which  animals  or 
plants  become  adapted  to,  and  so  thrive  in,  a  climate 
different  from  that  in  which  they  are  indigenous.  For 
instance,  almost  all  the  domestic  animals  were  originally 
natives  of  warm  climates.  As  regards  man,  Arnould 
states  that  the  race  is  acclimatized  when  it  preserves  (1) 
the  natural  increase  in  population;  (2)  its  normal  lon- 
gevity; (3)  its  aptitude  for  physical  and  intellectual  work. 
He  gives  the  following  as  conditions  favorable  to  the 
acclimatizing  process:  1.  Slight  alteration  in  the  lati- 
tude: to  proceed  from  a  warmer  to  a  colder  climate  is  an 
advantage.     2.   Ethnical    disposition.     3.    Manners   and 


48  ■  AIR. 

customs.  It  is  essential  to  adapt  one's  diet  to  the  climate. 
Clothing  and  general  habits  should  also  be  assimilated  to 
the  altered  conditions  of  climate.  4.  i\ptitude  for  cross- 
breeding. 5.  Soil  and  locality:  where  the  soil  is  not  un- 
healthy, acclimatization  is  much  simplified;  if  an  un- 
healthy soil  is  made  healthy,  by  drainage,  etc. 

Ground-air. — The  atmosphere  does  not  stop  at  the 
surface  of  the  soil,  but  penetrates  into  all  the  pores  and 
crevices.  The  proportion  of  air  in  the  soil  is  not  great 
where  there  are  no  fissures  or  clefts,  but  in  the  superficial 
layer  air  is  always  present  in  appreciable  proportions, 
and  especially  so  in  made  soil.  Soil-air  is  of  somewhat 
different  composition  than  the  atmospheric  air.  We  find 
present  in  it  large  quantities  of  the  products  of  putrefac- 
tion, which  is  very  active  in  the  soil.  It  is,  therefore, 
far  richer  in  carbon  dioxid,  besides  containing  other 
hydrocarbons  as  the  result  of  putrefaction,  principal 
among  which  is  marsh  gas.  In  subterranean  caverns  the 
air  may  have  undergone  such  an  amount  of  change  as 
the  result  of  putrefaction  and  chemical  changes  going  on 
in  the  rocks  that  it  is  not  fit  for  respiration,  and  ma}-  be 
highly  inflammable  as  the  result  of  the  admixture  of 
other  gases.  Soil-air  is  therefore  injurious  if  inhaled  in 
large  quantities  and  for  a  long  time.  It  tends  to  pene- 
trate into  houses  from  the  surrounding  soil,  because  the 
warmer  air  of  the  house  has  an  upward  tendency  and 
thus  abstracts  the  air  from  the  soil.  For  this  reason 
newly  made  soil  is  considered  unhealthy  and  should  be 
avoided.  This  is  especially  the  case  with  the  newly 
made  soil  in  and  around  cities,  where  the  materials  em- 
ployed in  making  the  soil  are  frequently  such  as  are 
capable  of  undergoing  putrefaction. 

Sewer-air. — Sewer-air  in  properly  constructed  modern 
sewers  is  merely  atmospheric  air  which  contains  a  slight 
excess  of  carbon  dioxid  and  small  amounts  of  gases 
resulting  from  putrefaction  taking  place  in  the  sewage. 
Consequently  there  is  also  a  slight  decrease  in  the  pro- 
portion of  oxygen  present.     The    proportion  of  micro- 


THE  IMPURITIES  IN  AIR.  49 

organisms  is  usually  less  than  that  of  the  air  of  streets 
and  houses,  and  they  are  usually  harmless  species.  The 
movement  of  air  in  sewers  is  rather  slow,  and  affords 
abundant  opportunity  for  the  suspended  particles,  along 
with  the  micro-organisms,  to  become  deposited  on  the 
moist  walls  of  the  sewer.  When  a  portion  of  a  sewer  or 
the  drainage-pipes  of  a  house  become  obstructed,  so  that 
there  is  no  longer  a  free  circulation  of  air  in  the  ob- 
structed portion,  then  there  is  an  accumulation  of  putre- 
factive gases,  such  as  carbon  dioxid,  hydrogen  sulphid, 
marsh  gas,  etc.,  and  these  gases  are  highly  injurious 
when  inhaled  in  considerable  quantities  or  in  smaller 
amounts  for  a  considerable  time. 

The  Impurities  in  Air. — These  are  either  gaseous  or 
solid.  The  more  important  gaseous  impurities  in  air  are 
carbon  monoxid  and  dioxid,  marsh  gas,  hydrogen  sul- 
phid, gaseous  organic  substances — such  as  amins,  ammo- 
nia, and  volatile  fatty  acids.  The  solid  impurities  in  air 
are  various  forms  of  dust,  inorganic  and  organic;  the 
debris  of  vegetable  and  animal  organisms,  and  living 
micro-organisms. 

Sources  of  the  Impurities. — Impurities  due  to  Respira- 
tion.— The  changes  that  take  place  in  air  that  has  been 
respired  are  both  chemical  and  physical.  (1)  The  volume 
of  the  expired  air  is  from  one-fiftieth  to  one-fortieth  less 
than  that  taken  in  at  the  corresponding  inspiration.  (2) 
The  temperature  is  raised,  as  a  rule,  to  that  of  the  blood. 
(3)  Owing  to  this  rise  in  the  temperature  there  is  actually 
an  increase  in  volume  of  the  expired  over  the  inspired 
air  to  an  extent  of  about  one-ninth  of  the  latter.  (4)  There 
is  an  increase  in  the  amount  of  carbon  dioxid  to  between 
4  and  5  per  cent.  (5  and  6)  There  is  an  increase  of 
ammonia  and  watery  vapor.  (7)  The  nitrogen  is  generally 
increased,  but  sometimes  diminished.  (8)  The  oxygen  is 
diminished  to  about  16  per  cent.  There  is  an  addition 
to  the  air  of  (9)  hydrogen,  do)  marsh  gas,  and  (11)  or- 
ganic matter.  Of  these  alterations,  the  most  important 
are  the  increase  in  the  amount  of  carbon  dioxid  and  the 
4 


50  AIR. 

corresponding  decrease  in  the  amount  of  oxygen,  the 
increase  of  the  aqueous  vapor  to  saturation,  and  the  ad- 
dition of  organic  matter. 

Carbon  Dioxid. — The  amount  of  carbon  dioxid  ex- 
creted has  been  variously  estimated  at  from  31.5  to  37.5 
grams  per  hour.  According  to  Pettenkofer  and  Voit,  the 
total  amount  excreted  in  twenty-four  hours  for  male 
adults  is,  on  an  average,  800  grams,  or  406  liters;  and 
according  to  Vierordt,  900  grams,  or  455.5  liters.  Assum- 
ing the  tidal  air  of  each  respiration  to  measure  500  cubic 
centimeters,  and  to  contain  4  per  cent,  of  carbon  dioxid, 
and  that  17  respirations  are  taken  every  minute,  then 
the  carbon  dioxid  excreted  in  one  hour  is  500  X  0.04 
X  17  X  60  =  20.4  liters,  or  489.6  liters  in  twenty-four 
hours. 

Aqueous  Vapor. — The  expired  air  is  nearly  always  sat- 
urated with  aqueous  vapor.  The  absolute  amount  varies 
with  the  temperature  of  the  expired  air;  but  this  itself 
varies  very  slightly,  being  nearly  that  of  the  blood,  rang- 
ing from  33. 8°  to  36.  i°  C.  According  to  Vierordt,  330 
grams  of  water  are  given  off  from  the  lungs  in  twenty- 
four  hours;  and  according  to  Valentine,  640  grams. 
Pettenkofer  and  Voit  state  that,  with  the  temperature  of 
the  atmosphere  at  150  C.  and  the  relative  humidity  at  75 
per  cent.,  an  adult  gives  off  286  grams  of  water  from  the 
lungs  in  twenty-four  hours. 

Organic  Matter. — That  organic  matter  is  present  in 
the  expired  air  is  obvious  from  its  odor,  which  is  often 
quite  fetid,  and  from  the  fact  that  when  it  is  collected  by 
the  condensation  of  the  aqueous  vapor  it  is  putrescible. 
It  has  been  supposed  by  some  that  this  organic  matter  is 
derived  from  the  alimentary  canal  and  from  the  upper 
portion  of  the  respiratory  tract,  but  it  has  apparently 
been  found  in  air  drawn  directly  from  the  trachea.  The 
greater  portion  of  it,  however,  arises  from  decomposing 
particles  of  food  lodged  between  the  teeth,  and  only 
a  small  portion  of  it  comes  directly  from  the  lungs. 
A  small  portion  of  it  is  also  derived  from  the  mucous 


THE  IMPURITIES  IN  AIR.  51 

membrane   of  the   pharynx  and  larynx  and,   probably, 
from  the  stomach. 

The  nature  of  the  organic  matter  is  not  known  with 
certainty.  It  decolorizes  solutions  of  potassium  perman- 
ganate, and  is,  therefore,  capable  of  being  oxidized. 
When  distilled  it  is  broken  up  and  yields  ammonia,  and 
is,  therefore,  nitrogenous.  It  is  molecular  rather  than 
gaseous,  and  is  probably  in  combination  with  water,  be- 
cause those  substances  which  are  most  hygroscopic  ab- 
sorb most  organic  matter.  The  quantity  of  organic 
matter  given  off  with  the  expired  air  has  been  estimated. 
Cornelly,  Haldane,  and  Anderson  found,  in  ten  observa- 
tions, that  the  amount  of  oxygen  required  to  oxidize  the 
organic  matter  varied  from  1.7  to  13.6  milligrams  per 
liter  of  condensed  vapor,  giving  an  average  of  7.6  and 
8.3  milligrams  for  two  observers,  respectively.  Lehmann 
and  Jessen  found  that  between  3  and  4  milligrams  of 
oxygen  were  required  to  oxidize  the  organic  matter  in  a 
liter  of  condensed  vapor.  Ransome's  results  indicate  the 
exhalation  of  20  milligrams  of  organic  matter  in  twenty- 
four  hours,  and  Beu's  results,  15  milligrams.  In  my 
own  experiments 1  I  found  the  quantity  of  organic  matter 
in  the  expired  air  of  healthy  men  to  be,  on  an  average, 
10.72  milligrams  per  liter  of  condensed  vapor.  I  found 
also  that  the  amount  of  organic  matter  is  much  greater 
three  to  four  hours  after  a  meal  than  immediately  after 
eating,  and,  likewise,  that  the  amount  is  directly  de- 
pendent upon  the  degree  of  cleanliness  of  the  mouth  and 
teeth  of  the  person  from  whom  the  vapor  is  collected; 
the  average  amount  four  hours  after  meals  was  11.98 
milligrams,  half  an  hour  after  meals  it  was  only  3.86 
milligrams  when  the  mouth  and  teeth  had  remained  un- 
cleaned  for  several  days,  while  the  average,  four  hours 
after  meals,  was  only  2.49  milligrams  when  the  teeth  had 
first  been  brushed  and  the  mouth  thoroughly  rinsed  with 
warm  water.  The  amount  of  organic  matter  is  also 
greater  in  those  having    decayed   teeth    than    in   those 

1  Smithsonian  Contributions  to  Knowledge,  989,  Washington,  D.  C,  1895. 


52  AIR. 

having  sound  teeth.  In  vapor  condensed  from  the  breath 
of  a  man  having  an  opening  directly  into  the  trachea, 
and  in  whom  there  was  no  communication  between  the 
trachea  and  pharynx,  I  found  the  average  for  three  ob- 
servations to  be  9.68  milligrams.  In  a  consumptive 
person  I  found  the  average  amount  to  be  17.34  milli- 
grams. I  found  the  average  amount  of  nitrogenous  or- 
ganic matter  given  off  with  the  expired  air  to  be  17.5 
milligrams  of  free,  and  9.0  milligrams  of  albuminoid, 
ammonia  per  liter  of  condensed  vapor,  for  healthy  persons; 
and  0.3  milligram  of  free,  and  3.4  milligrams  of  albu- 
minoid, ammonia  in  that  of  consumptive  persons. 

Bacteria  in  Expired  Air. — No  bacteria  are  given  off 
with  the  expired  air  in  ordinary,  quiet  respiration.  In 
the  forcible  expirations  during  speaking,  coughing,  or 
sneezing  it  has  been  found  that  small  particles  of 
mucus  and  moisture  are  thrown  off  which  carry  micro- 
organisms. In  this  manner  a  person  suffering  from  the 
various  infectious  diseases  may  infect  the  atmosphere  and 
the  furniture  of  the  room  in  which  he  lives. 

Impurities  due  to  Perspiration. — The  secretions  of  the 
skin  consist  of  sweat  proper  (an  acid,  watery  fluid  con- 
taining about  1.8  per  cent,  of  solids)  and  of  sebaceous 
matter,  and  the  quantity  varies  greatly  according  to  the 
temperature  and  humidity  of  the  air,  the  amount  of  ex- 
ertion, etc.,  but  may  be  taken  as  ranging  from  800  to 
1000  cubic  centimeters  during  twenty-four  hours.  Epi- 
thelial cells  are  constantly  disengaged  from  the  skin. 
Considerable  amounts  of  carbon  dioxid  are  also  given 
off  through  the  skin. 

Impurities  due  to  Combustion. — The  principal  impuri- 
ties due  to  combustion  are  carbon,  carbon  monoxid,  car- 
bon dioxid,  sulphur,  sulphur  dioxid,  sulphuric  acid, 
sometimes  hydrogen  sulphid,  ammonia  compounds,  and 
water. 

The  impurities  arising  from  illuminating-gas  are  ole- 
fiant  gas  and  other  hydrocarbon  vapors,  hydrogen,  carbon 
monoxid,  and  marsh  gas.     Besides  these  normal  constitu- 


THE  IMPURITIES  IN  AIR.  53 

ents  of  the  gas  we  frequently  find  present  carbon  dioxid, 
hydrogen  sulphid,  and  other  sulphur  compounds. 

Impurities  in  the  Air  of  Work-rooms  and  Factories. — 
The  air  of  work-rooms  and  factories  contains  the  im- 
purities arising  from  the  respiration  and  perspiration 
of  the  occupants,  and,  in  many  instances,  also  the  pro- 
ducts of  combustion  arising  from  the  process  of  heating 
and  lighting.  Such  rooms  are  often  overcrowded  and 
overheated,  and  in  consequence  these  impurities  are 
present  in  excessive  amounts,  while  from  lack  of  per- 
sonal cleanliness  there  is  a  greater  proportion  of  the 
organic  impurities  arising  from  perspiration. 

The  special  impurities  of  the  air  resulting  from  the 
manufacturing  processes  present  one  or  the  other  of  the 
following  conditions:  (a)  Increase  of  temperature,  as  in 
mines  or  bake-houses,  the  "gassing"  rooms  of  silk 
mills,  and  the  "sizing"  sheds  of  cotton  mills,  (b)  Ex- 
cessive humidity,  as  in  some  deep  mines  and  in  the 
"sizing"  sheds  of  cotton  mills,  (c)  The  presence  of 
deleterious  gases;  in  mines  carbon  monoxid  and  dioxid, 
carburetted  hydrogen  and  hydrogen  sulphid  may  be  pres- 
ent; in  bleaching  works  sulphur  dioxid  is  evolved,  and 
also  in  copper  works,  though  in  the  latter  it  at  once  passes 
into  the  outer  air.  (d)  Vapors  of  hydrochloric,  sulphuric, 
and  nitric  acids,  and  of  chlorin  are  given  off  in  cer- 
tain processes  of  the  manufacture  of  steel,  (e)  Carbon 
disulphid  is  present  in  the  air  of  vulcanized  India-rubber 
works.  (/)  The  fumes  of  phosphorus  in  match-making, 
and  (g)  the  fumes  of  zinc  in  brass  founding;  (k)  arsenical 
fumes  in  copper-smelting,  the  preparation  of  wall-paper, 
the  manufacture  of  artificial  flowers,  and  in  the  prepara- 
tion of  skins  for  mounting;  and  (i)  mercurial  vapors  are 
given  off  in  bronzing  and  gilding,  and  in  the  manufact- 
ure of  artificial  flowers. 

Impurities  in  the  Air  of  Dwellings. — The  impurities 
in  the  air  of  houses  are  those  arising  from  respiration, 
perspiration,  and  combustion,  and,  in  addition,  arsenical 
vapors  may  be  present  when  the  walls  are  covered  with 


54  AIR. 

paper  containing  arsenic.  In  cities  the  air  of  houses 
may  also  contain  impurities  arising  from  sewers  or  from 
cesspools. 

Dust  in  the  Air. — The  most  injurious  constituent  of 
the  air  in  certain  manufactories  and  in  the  air  of  the 
streets  of  cities  is  dust.  Mineral  dust  is  given  off  in 
certain  manufacturing  processes  and  in  mines.  This  is 
especially  injurious  in  establishments  where  cutlery  and 
files  are  made,  also  in  gun  factories.  Dust  of  vegetable 
origin  is  given  off  in  the  wood-working  manufactories. 
The  hard  woods  used  in  cabinet-making  are  especially 
injurious.  In  factories  where  hides  and  feathers  are  used 
dust  of  animal  origin  is  found.  In  the  arrangement  of 
modern  manufacturing  establishments  much  of  the  danger 
from  dust  particles  is  overcome  by  special  arrangements, 
by  means  of  which  the  dust  is  extracted  from  each 
machine  and  is  removed  by  a  special  flue  by  means  of 
a  strong  current  of  air. 

Examination  of  the  Air  by  the  Senses. — Imme- 
diately on  entering  the  place  where  the  air  is  to  be 
examined,  note  the  condition  of  the  air  as  presented  to 
the  olfactory  sense.  Note  whether  it  is  fresh  and  sweet, 
rather  close,  very  close,  or  fetid.  The  odor  of  animal 
organic  matter  when  present  in  the  air,  even  in  small 
amounts,  is  very  offensive  and  readily  detectable,  if  the 
first  impression  on  entering  be  noted;  after  half  a  minute 
this  impression  wears  off.  The  readiness  with  which  it 
is  perceived  depends  largely  on  the  humidity  of  the  air, 
more  so  than  on  the  increase  of  the  temperature.  A  rise 
of  i  per  cent,  in  the  humidity  has  as  much  influence  on 
the  condition  of  the  air  space,  as  judged  by  the  sense  of 
smell,  as  a  rise  of  2.320  C.  in  the  temperature. 

The  recognition  of  the  presence  of  organic  matter  in 
the  air  is  the  most  important  item  of  information  to  be 
gained  by  the  senses;  but  the  presence  of  illuminating- 
gas  or  any  abnormal  smell  should,  of  course,  also  be 
noted,  as  well  as  the  humidity  of  the  air  and  the  pres- 
ence of  notable  quantities  of  dust. 


DISEASES  PRODUCED  BY  IMPURE  AIR.  55 

Chemical  Analysis  of  Air. — This  includes,  first  and 
most  important,  the  determination  of  the  proportion  of 
carbon  dioxid,  since  this  is  commonly  taken  as  a  measure 
of  the  other  impurities  in  the  air;  second,  the  estimation 
of  the  humidity  of  the  air;  and,  third,  the  determination 
of  the  quantity  of  oxidizable  organic  matter,  as  shown 
by  the  potassium  permanganate  test.  A  more  complete 
chemical  analysis  would  include  the  estimation  of  the 
amount  of  oxygen  present,  the  amount  of  ammonia  (free 
and  albuminoid),  the  amount  of  nitrous  and  nitric  acids, 
of  hydrogen  sulphid,  etc.,  in  the  air.  The  proportion  of 
carbon  dioxid  in  the  outside  air  should  always  be  deter- 
mined at  the  same  time.  The  excess  of  carbon  dioxid 
in  the  inside  air  over  that  in  the  outside  air  is  termed  the 
"respiratory  impurity"  of  the  air.  When  it  is  impos- 
sible to  analyze  the  outside  afr,  0.4  may  be  taken  as  the 
average  volume  of  carbon  dioxid  per  1000  volumes  of 
air. 

The  proportion  of  organic  matter  can  only  be  deter- 
mined indirectly,  either  by  estimating  the  amount  of 
oxygen  required  for  its  oxidation,  or  by  determining 
the  amount  of  nitrogenous  organic  matter  from  the  quan- 
tity of  free  and  albuminoid  ammonia  obtained  through 
distillation. 

Diseases  Produced  by  Impure  Air. — Carbon  Dioxid. 
— This  gas  is  poisonous  in  large  proportions,  exceeding  1 
or  2  per  cent. ;  but  there  is  no  doubt  that  the  constant 
presence  of  even  smaller  amounts  for  long  periods  of 
time  induces  a  progressive  depression  of  the  vitality, 
thus  constituting  a  preparation,  and  constituting  a  pre- 
disposing cause,  for  many  diseases.  The  bad  effects 
produced  by  breathing  air  vitiated  by  respiration  are  in 
part,  though  not  entirely,  due  to  the  contained  carbon 
dioxid. 

Carbon  Monoxid. — This  is  a  powerful  narcotic  poison. 
Its  poisonous  action  depends  on  the  formation  of  a  new 
and  quite  stable  compound  with  the  hemoglobin  of  the 
blood,  the  oxygen  being  entirely  displaced.     It  produces 


56  AIR. 

unconsciousness,  paralysis  of  the  heart,  and,  at  high  tem- 
peratures, convulsions.  Small  quantities  cause  headache, 
giddiness,  and  speedy  insensibility.  A  mixture  of  carbon 
monoxid  and  dioxid  seems  to  be  more  poisonous  than  the 
monoxid  alone. 

Hydrogen  Sulphid. — This  gas  acts  as  a  narcotic  poison; 
i  volume  per  iooo  volumes  of  air  being  fatal  to  dogs.  The 
chronic  effects  produced  by  the  inhalation  of  small  quan- 
tities are  depression,  digestive  disturbances,  and  anemia, 
with  narcotic  or  convulsive  symptoms  in  more  acute  and 
severe  cases. 

Effects  of  Vitiated  Air  Generally. — Vitiation  by 
Respiration  and  Perspiration. — It  is  impossible  to  sepa- 
rate the  effects  produced  by  these  two  forms  of  vitiation 
from  one  another,  nor  is  it  necessary,  as  they  always 
coexist.  In  addition,  the  emanations  from  the  alimen- 
tary tract  are  also  a  possible  source  of  impurity.  The 
effects  produced  by  vitiated  air  of  this  character  may 
be  divided  into  two  classes,  those  of  extreme  vitiation 
acting  for  a  short  time,  and  slighter  vitiation  extending 
over  a  long  period  of  time. 

Extreme  vitiation  for  a  short  time,  as  produced  by 
great  overcrowding,  may  cause  death  from  deficiency  of 
oxygen  and  excess  of  carbon  dioxid  in  the  air  breathed. 
It  was  supposed  until  recently  that  a  large  share  of  the 
effects  produced  by  such  an  atmosphere  was  traceable  to 
the  organic  matter  present  in  expired  air,  but  at  present 
there  is  no  convincing  evidence  that  such  is  the  case. 
On  the  other  hand,  recent  experiments  on  animals  indi- 
cate that  deficiency  of  oxygen,  excess  of  carbon  dioxid, 
increased  temperature,  with  high  relative  humidity  of 
the  air,  are  the  principal  factors  in  producing  the  effects. 
The  increased  temperature  and  high  relative  humidity 
of  the  air  are  probably  most  important  factors  in  pro- 
ducing the  effects  through  their  operation  upon  the  heat- 
regulating  functions  of  the  body. 

Slighter  vitiation  of  the  air  when  continued  for  some 
time  causes  anemia,  weakness,  and  general  depression  of 


EFFECTS  OF  VITIATED  AIR  GENERALLY.       57 

the  vital  forces,  nutrition  being  gravely  interfered  with. 
Pulmonary  affections  appear  to  be  produced,  either 
directly  or  indirectly,  by  causing  a  predisposition  to 
them.  Such  conditions  of  the  air  are  met  with  in 
confined  workshops  and  in  overcrowded  schools.  In 
many  instances  the  effects  of  breathing  impure  air  are 
complicated  with  the  sedentariness  of  the  occupation  and 
its  consequent  interference  with  the  normal  functions  of 
the  body;  poverty  and  insufficient  nourishment  being 
frequent  concomitants.  It  is  a  matter  of  fact  that  head- 
ache, malaise,  want  of  appetite  and  of  energy,  are  caused 
by  habitual  breathing  of  impure  air. 

The  prevalence  of  certain  diseases  of  the  lungs  in  those 
constantly  breathing  impure  air  indicates  a  causative 
relation.  The  prevalence  of  phthisis  among  soldiers 
and  sailors  was  considered  to  be  due  to  impure  air  by 
Parkes  and  many  other  competent  observers.  With  the 
improvement  of  the  ventilation  of  their  quarters  phthisis 
has  diminished.  Notwithstanding  the  indications,  im- 
pure air  is  not  directly  the  cause  of  phthisis;  only  indi- 
rectly, through  the  lowered  vitality  it  produces  and  the 
facilities  it  affords  for  the  transmission  of  the  specific 
micro-organisms.  The  reduction  in  the  number  of  cases 
of  phthisis  among  soldiers  and  sailors  resulting  from 
improvement  in  the  ventilation  of  their  quarters  is 
brought  about  through  the  increased  vitality  induced, 
and  through  the  greater  dilution  of  the  impurities  in  the 
air — the  tubercle  bacilli — and,  in  consequence,  the  facili- 
ties for  their  transmission  are  less  favorable.  The  preva- 
lence of  pneumonia  also  appears  to  bear  some  relation  to 
the  degree  of  purity  of  the  respired  air.  Typhus  fever 
spreads  rapidly  in  crowded  dwellings,  but  with  free  ven- 
tilation it  is  rendered  less  dangerous,  if  not  entirely 
harmless.  In  all  the  specific  zymotic  diseases,  but 
especially  in  typhus  fever,  light  and  oxygen  are  the 
greatest  enemies  to  the  disease. 

Effects  of  Air  Vitiated  by  Combustion. — Generally 
speaking,  the  gaseous  products  of  combustion  are  diffused 


58  AIR. 

so  rapidly  that  there  is  no  prejudicial  effect  on  health; 
but  in  some  instances,  as  in  crowded  work-rooms,  where 
much  gas  is  burned,  and  in  hot,  crowded  places,  such  as 
theaters,  the  effects  are  obvious  and  not  to  be  disregarded. 
The  effects  produced  by  such  air  when  inhaled  constantly 
are  anemia,  vital  depression,  headache,  and  sometimes 
gastric  derangement  when  the  exposure  is  only  for  a 
few  hours. 

Effects  of  Solid  Impurities  in  Air. — -The  solid  impuri- 
ties in  the  air  may  produce  irritation  of  the  mucous  mem- 
brane of  the  respiratory  tract  and  lead  to  bronchitis  and 
laryngitis.  The  effects  of  the  solid  impurities  are  most 
frequently  seen  in  those  following  certain  occupations, 
as  in  coal-mining,  cotton-weaving,  emery-grinding, 
polishing  of  metals,   etc. 

In  the  pottery  trade  the  workmen  are  exposed  to  dust, 
and  as  a  result  emphysema  is  quite  common,  and  is 
known  as  "potters'  asthma."  Grinding  of  steel,  espe- 
cially of  the  finer  tools,  is  very  dangerous  unless  wet- 
grinding  is  employed  or  proper  ventilation  is  introduced. 
The  makers  of  pearl  buttons  suffer  from  chronic  bron- 
chitis. In  the  textile  industries  the  fine  particles  of  wool, 
flax,  and  cotton  floating  in  the  air  are  injurious.  The 
makers  of  matches  are  not  infrequent  sufferers  from 
phosphorus-poisoning. 


CHAPTER   II. 
VENTILATION. 

By  the  term  ventilation  we  understand  the  continuous 
introduction  of  pure  air  into  a  room  or  building,  thor- 
oughly mixing  it  with  the  contained  air,  and  the  simul- 
taneous extraction  of  a  like  quantity  of  impure  air.  The 
ventilation  of  rooms  and  buildings  is  necessary  in  order 
to  prevent  the  accumulation  of  the  impurities  of  respira- 
tion, perspiration,  and  combustion. 

Diffusion  of  Gases. — The  principles  employed  in  ordi- 
nary ventilation  depend  upon  a  property  common  to  all 
gases — that  of  diffusion.  Gases  which  have  no  chemical 
affinity  for  each  other  will  mingle  regardless  of  their 
relative  weight  or  density,  and  form  a  perfectly  uniform 
mixture.  The  time  required  for  the  diffusion  of  gases 
is  inversely  proportional  to  the  density,  and  directly  pro- 
portional to  the  square  root  of  the  absolute  temperature. 

Amount  of  Fresh  Air  Required. — Amount  of  Fresh 
Air  Respired. — The  quantity  of  air  taken  into  the  lungs 
by  an  adult  person  at  each  ordinary  inspiration  averages 
500  cubic  centimeters.  Assuming  that  17  inspirations  are 
taken  each  minute,  the  total  amount  of  air  inspired  in 
twenty-four  hours  is  12,240  liters.  About  5  per  cent,  of 
the  oxygen  contained  in  the  inhaled  air  is  absorbed.  If 
17,000  liters  of  air  are  inhaled  in  twenty-four  hours,  850 
liters,  or  1200  grams,  of  oxygen  are  absorbed.  These 
figures  are  based  on  results  obtained  when  a  fair  amount 
of  exercise  is  taken.  A  man  of  average  weight  excretes 
17  liters  of  carbon  dioxid  per  hour  in  repose,  25.5  liters 
with  gentle  exertion,  and  51  liters  with  hard  work. 
Weight  for  weight,  children  give  off  about  twice  as  much 
carbon  dioxid  as  adults. 

59 


6o 


VENTILA  TION. 


The  Standard  of  Purity. — The  air  under  ordinary  con- 
ditions contains  about  4  parts  of  carbon  dioxid  per  10,000 
parts,  and  the  standard  of  purity  for  the  air  of  dwellings 
is  not  to  exceed  6  parts  in  10,000,  thus  allowing  an  excess 
of  2  parts  per  10,000  as  "respiratory  impurity."  The 
amount  of  fresh  air  required  in  order  to  maintain  the 
standard  of  purity  in  the  air  of  dwellings  can  be  very 
readily  determined,  provided  we  know  the  velocity  with 
which  the  air  enters,  the  size  of  the  openings,  and  the 
number  of  persons  in  the  room. 

If  we  take  the  proportion  of  carbon  dioxid  in  the  air 
as  an  index  of  the  character  of  the  ventilation,  the 
method  of  calculating  the  amount  of  fresh  air  required 
to  maintain  the  standard  of  purity  is  based  on  the  follow- 
ing data:  The  amount  of  carbon  dioxid  exhaled  per  head 
per  hour,  and  the  ratio  per  1000  of  respiratory  impurity. 

The  calculation  is  made  according  to  the  formula —  =  </, 

r 
where 

e  =.  the  amount  of  C02  expired,  in  liters,  per  head  per  hour, 
r=  the  ratio  per  iooo  of  C02 — the   permissible  limit  due  to  respiratory  im- 
purity, and 
d=  the  delivery  of  fresh  air  per  hour,  expressed  in  cubic  meters. 

Example  I  :  Let  e  =  17  liters,  the  average  amount  for  a  mixed  audience  in 
repose,  and  ;-  =  o.  2  volume  per  1000,  then  17  H-  0.2  =  85  cubic  meters  or 
85,000  liters  of  fresh  air  per  head  per  hour. 

Example  2  :   With  gentle  exertion  an  adult  man  excretes  25.5  liters  of  car- 

bon  dioxid  per  hour.      Then  the  formula  _  =  d  becomes     D'D  __   x-,7  r    cubic 

r  0.2  '"-' 

meters  or  127,500  liters  per  head  per  hour.      It  has  been  found  that  the  amount 

of  air  required  per  hour,  in  liters,  is  as  follows  : 


In  repose. 

Gentle  exertion. 

Hard  work. 

Adult  males     .    .    . 
Adult  females  .    .    . 

85,000 
57,000 
42,500 

127,500 
85,000 
63,750 

255,000 
170,000 
113,000 

For  muscular  adults  a  larger  amount  of  fresh  air  must 
be  supplied  than  the  average  amounts  given.  A  larger 
amount  should  also  be  supplied  for  the  sick  than  for  the 
healthy;  an  increase  of  one-fourth  of  the  air-supply  being 


CUBIC  SPACE. 


61 


necessary  for  hospitals,  cr  106.25  cubic  meters,  or  106,250 
liters,  per  head  per  hour. 

The  amount  of  carbon  dioxid  given  off  by  school  chil- 
dren may  be  assumed  to  be  10  liters,  for  a  candle  12,  for 
a  petroleum  lamp  60,  and  for  a  gas  flame  100  liters;  con- 
sequently in  artificially  lighted  rooms  additional  space 
must  be  provided  to  prevent  the  accumulation  of  an  ex- 
cess of  carbon  dioxid.  The  amount  of  additional  ven- 
tilation required  for  each  form  of  illumination  can  be 
calculated  in  the  same  manner  as  already  indicated  by 
substituting  the  corresponding  amounts  of  carbon  dioxid 
yielded  by  each;  for  instance,  a  gas  flame  would  require 

—  =  d,  where  e  =  100,  instead  of  17,  as  in  the  first  example 
r 

given. 

According  to  Hueppe,  the  degree  of  pollution  of  the 

air  through  different  causes  may  be  determined  by  taking 

into  consideration  the  amount  of  carbon   dioxid,   heat, 

and  watery  vapor  given  off  by  a  person  or  by  any  of  the 

more  common  sources  of  illumination.     The  necessary 

data  are  contained  in  the  following-  table: 


Development  of 

COo  per  hour 

.in  liters. 

Heat 

in 

calories. 

Watery  vapor, 
in  grams 
per  hour. 

Child 

IO.O 
I7.O 
20.0 

36-o 

52 

90 

I30 

255 

Youth 

Man,  resting 

40 
60 

15.0 
56-61 
31-56 

90 
109 

I06 
430-580 
2OO-39O 
600-875 
80O-9OO 

IO-I2 

Gas  light,  flat  burner   .    .    . 
Gas  light,  Argand  burner    . 

35-40 

26-40 

I30 

157 

Cubic  Space. — The  amount  of  cubic  space  provided 
for  each  person  depends  to  some  extent  on  the  nature  of 
the  occupation,  and  on  the  ease  with  which  the  contained 
air  can  be  replenished.  If  85  cubic  meters  of  fresh  air 
are  to  be  supplied  per  head  per  hour,  it  is  obvious  that 
this  can  be  more  readily  effected  in  a  room  of  25  cubic 
meters  capacity  than  in  one  of  only  half  the  capacity 


62 


VENTILA  TION. 


without  producing  disagreeable  draughts.  The  incoming 
air  must  not  have  such  a  velocity  as  to  make  itself  felt  to 
any  marked  degree.  It  is  essential  that  the  production 
of  draughts  be  avoided.  The  inlet  openings  should  not 
be  too  large,  and  should  be  so  placed  that  the  current  of 
incoming  air  does  not  strike  any  part  of  the  bodies  of  the 
occupants  of  the  rooms.  The  temperature  of  the  incom- 
ing air  must  be  so  regulated  that  its  movements  do  not 
create  the  sensation  of  draught. 

It  has  been  found  that  in  this  climate  the  air  can  be 
changed  satisfactorily  only  about  three  times  an  hour 
unless  it  is  introduced  at  a  temperature  above  i8°  C.  In 
order  that  85  cubic  meters  of  air  may  be  supplied,  the  cubic 
space  for  each  person  should  be  about  one-third  as  large, 
or  28.3  cubic  meters.  For  hospitals  and  sick-rooms  the 
cubic  space  must  be  increased  in  the  same  proportion  as 
in  the  fresh  air-supply  by  about  one-fourth,  so  as  to  pro- 
vide a  space  of  35  to  37  cubic  meters  per  head.  For 
cases  of  infectious  diseases  a  still  larger  space  should  be 
provided.  In  schools,  as  a  rule,  the  cubic  space  provided 
is  very  small  in  proportion  to  the  space  required  theo- 
retically. In  the  schools  of  France  and  England  the  cubic 
space  per  head  ranges  from  2.83  to  4.675  cubic  meters. 
In  the  modern  school  buildings  of  Philadelphia  only  about 
5.6  cubic  meters  are  provided  for  each  pupil,  and  the  air 
is  changed  about  seven  times  an  hour.  With  the  modern 
systems  of  ventilation  now  in  use  this  amount  of  space  is 
possibly  not  much  too  low  to  meet  the  desired  results. 

According  to  Morin,  we  require — 


Amount  of  ventilation 

in  cubic  meters  per 

hour  per  person. 


Maximum 
cubic  space. 


For  hospitals 

For  prisons 

For  factories 

For  barracks 

For  theaters 

For  halls  and  assembly-rooms 

For  schools 

For  class-rooms  for  adults  .    . 


60-100 

5° 
60-100 

30-  50 
40-  50 
30-  60 
15-  20 

25-  SO 


30    -50 

25 
30    -50 

15    -25 
20    -25 

15    -30 

7-5-i° 
12   -15 


NATURAL    VENTILATION.  6$ 

It  will  be  noted  that  Morin  allows  for  a  complete 
change  of  air  only  twice  each  hour.  Where  more  fre- 
quent changes  of  air  can  be  definitely  secured  a  smaller 
amount  of  cubic  space  per  person  may  give  satisfactory 
results. 

General  Rules  for  Ventilation. — The  quality  of  the 
incoming  air  is  of  equal  importance  with  the  quantity; 
therefore,  care  must  be  exercised  in  selecting  the  source 
of  the  air-supply.  In  large  towns  it  may  be  necessary  to 
wash  or  filter  the  air  before  it  is  distributed. 

The  current  of  incoming  air  should  be  imperceptible. 
This  is  of  special  importance  when,  as  is  generally  the 
case,  the  temperature  of  the  outer  air  is  lower  than  that 
of  the  air  of  the  building.  When  cold  draughts  are  pro- 
duced the  system  of  ventilation  is  faulty.  The  larger  the 
area  of  the  inlet  and  the  outlet  openings  the  slower  the 
velocity  of  the  air  current,  but  obviously  these  openings 
cannot  be  enlarged  indefinitely. 

The  fresh  air  must  not  only  be  supplied  to  a  space,  but 
it  must  also  be  diffused  equably  throughout  the  space,  so 
as  not  to  pass  directly  from  the  point  of  entrance  to  the 
point  of  exit.  It  is  very  difficult  practically  to  attain 
this  end,  but  unless  it  is  attained  we  fail  to  secure  the 
proper  displacement  and  renewal  of  the  vitiated  air. 

Ventilation  is  effected  either  by  natural  means  or  by 
the  aid  of  mechanical  contrivances.  The  former  is  called 
natural  ventilation  and  the  latter  artificial  ventilation. 

Natural  Ventilation. — In  all  buildings  there  is  an 
interchange  between  the  inside  and  outside  air  by  diffu- 
sion through  the  substance  of  the  walls  and  floors  them- 
selves, but  this  interchange  is  insufficient  to  replenish  the 
contained  air,  and  provision  must  be  made  to  supply  the 
necessary  amount  of  fresh  air  through  openings  in  the 
walls,  as  doors,  windows,  etc.,  or  through  special  open- 
ings into  ventilating  shafts;  the  latter  method  being  the 
preferable  one,  especially  for  large  assembly-halls  and 
school-rooms. 

The  forces  which  are  continually  acting  in  nature  and 


64  VENTILA  TION. 

produce  natural  ventilation  are  diffusion,  the  action  of 
the  wind,  and  the  difference  in  density  of  masses  of  air 
of  different  temperatures;  the  latter  being  the  most 
important. 

Diffusion. — All  gases,  including  the  mixture  of  oxy- 
gen and  nitrogen  which  constitutes  atmospheric  air,  dif- 
fuse through  space,  the  force  of  the  diffusion  being 
inversely  as  the  square  roots  of  the  densities  of  the  gases. 
The  diffusion  of  carbon  dioxid,  and  the  other  gaseous 
impurities  in  the  air  of  an  enclosed  space,  into  the  fresh 
air  takes  place  not  only  through  the  natural  openings  of 
rooms,  as  doors,  etc.,  but  also  through  the  walls,  floor, 
and  ceiling,  because  the  materials  of  which  these  are 
constructed  are  always  more  or  less  porous  and  perme- 
able. The  amount  of  ventilation  through  walls  varies 
with  the  porosity  of  the  materials  of  which  they  are 
formed;  the  temperature  of  the  inside  and  outside  air; 
the  force  and  direction  of  the  wind,  etc.  Damp  walls 
are  less  porous  than  dry  walls,  and  this  is  partly  the 
cause  of  the  unhealthfulness  of  damp  houses. 

The  Action  of  the  Wind. — This  is  exerted  in  two  ways: 
(i)  By  perflation — that  is,  blowing  through  an  air  space 
and  thus  changing  the  air  contained  therein;  and  (2)  by 
aspiration — that  is,  sucking  up  masses  of  air  in  conse- 
quence of  a  partial  vacuum  that  is  produced  on  either 
side  of  a  moving  mass  of  air.  Perflation  takes  place 
through  doors  and  windows,  as  well  as  through  walls 
and  ceilings.  In  the  wards  of  a  hospital,  where  thorough 
ventilation  is  of  especial  importance,  the  windows  should 
be  placed  on  both  sides  of  the  room,  so  as  to  allow  full 
sway  to  the  perflating  action  of  the  wind.  Aspiration  is 
provided  when  the  wind  blows  over  the  top  of  a  chimney 
or  ventilating  shaft  and  causes  an  upward  current  at  right 
angles  to  its  course.  A  strong  wind  may  impede,  instead 
of  aid,  the  movement  of  the  air  up  the  chimney,  as,  for 
example,  when  a  down  draught  takes  place,  producing  a 
smoking  chimney. 

Difference  in  Temperature. — The  movement  produced 


ARRANGEMENTS  IN  NA  TURAL    VENT/LA  TION.    65 

by  the  difference  in  weight  of  masses  of  air  of  different 
temperatures  is  the  chief  force  acting  in  natural  ventila- 
tion. When  a  mass  of  air  is  heated  it  expands,  and  pro- 
portionate volumes  of  it  become  lighter;  consequently  it 
rises  to  a  higher  plane  and  is  displaced  by  colder  and 
heavier  air.  The  greater  the  difference  in  the  tempera- 
ture of  masses  of  air  the  more  rapid  the  movement  that 
is  produced.  The  rate  of  movement  may  be  calculated 
according  to  either  of  the  following  rules: 

1.  The  velocity  of  falling  bodies  is  equal  to  the  square 
root  of  the  space  or  height  through  which  they  have 
fallen,  multiplied  by  the  square  root  of  twice  the  accel- 
erating force  of  gravity.      V==  1/  2  gr. 

2.  Rule  of  Montgolfier:  Fluids  pass  through  an  orifice 
in  a  partition  with  a  velocity  equal  to  that  which  a  body 
would  acquire  in  falling  through  a  space  or  height  equal 
to  the  difference  in  depth  of  the  fluids  on  the  two  sides 
of  the  partition. 

All  gases  under  constant  pressure  expand  equally. 
If  y=  the  volume  at  o°  C,  then  the  volume  at  /°  =  Kx 
(1  +  a  .  /),  where  a  =  0.003665.  The  effect  of  heat  on  air, 
therefore,  is  to  increase  its  volume  and  to  lessen  its  den- 
sity directly  in  proportion  to  the  increase  in  temperature. 

Arrangements  in  Natural  Ventilation. — In  cold  and 
temperate  climates  the  openings  that  are  usually  present 
in  inhabited  rooms  are  doors  and  windows.  Chimneys 
are  also  generally  present.  Ventilation  is  not  the  primary 
object  of  these  openings,  but  nevertheless  they  act  as 
ventilators,  and  in  very  many  instances  they  afford  the 
only  means  for  ventilation.  Diffusion  takes  place  through 
all  these  openings,  as  well  as  through  the  walls,  floors, 
and  ceilings,  and  generally  no  special  arrangements  are 
needed  to  assist  it  in  ordinary  dwellings. 

The  natural  ventilation  through  the  pores  of  the  walls 
is  of  slight  significance.  It  occurs  constantly  in  a  vertical 
direction  through  the  floor  and  ceiling.  In  winter,  when 
the  house  is  heated,  it  occurs  from  below  upward,  and  in 
summer  in  the  opposite  direction,  because  the  house  is 
5 


66 


VENTILA  TION. 


colder  than  the  outside  air.  Along  the  side  walls  the 
excess  of  pressure  diminishes  from  the  floor  to  the  ceil- 
ing, between  which  points  there  is  a  neutral  zone  where 
it  is  zero.  In  winter,  in  consequence  of  warming  the 
room  air,  there  is  an  outward  movement  above  this  zone, 
and  below  it  an  inward  movement  of  cold  outside  air 


Cold- 


Cold 


'Cold 


(see  Fig.  5);  the  reverse  takes  place  when  the  room  is 
colder  than  the  outside  air  (see  Fig.  6). 

The  perflating  action  of  the  wind  must  be  utilized  and 
regulated.      Open  doors  and  windows  allow  the  entrance 

Warm, 


Warm 


(4/arm. 


of  moving  masses  of  air,  but  if  the  movement  is  of  suffi- 
cient rapidity  to  produce  perceptible  currents  the  doors 
and  windows  will  probably  be  closed  and  the  perflating 


ARRANGEMENTS  IN  NA  TURAL   VENTILA  TION.    6j 


action  of  the  wind  arrested.  The  windows  should  always 
be  placed  on  opposite  sides  of  a  room  to  secure  free  per- 
flation and  thorough  change  of  the  air.  Even  if  this  can 
be  secured  only  at  intervals,  it  is  of  special  importance  in 
the  ventilation  of  wards  of  hospitals  and  of  school-rooms. 
If,  however,  some  arrangement  is  made  by  which  fresh 
air  may  be  brought  into  a  room  without  having  the  cur- 
rent impinging  directly  upon  the  occupants,  the  air  of 
the  room  can  be  renewed,  to  a  great  extent,  through  the 
force  of  the  wind.  A  simple  plan  by  which  this  can  be 
accomplished  is  to  have  the  upper  part  of  the  window- 
sash  sloping  inward,  so  as  to  direct  the  current  of  air 
upward  toward  the  ceiling,  where  it  is  distributed  to  all 
parts  of  the  room  and  slowly  falls  and  displaces  the  con- 
tained air.  Another  plan  is  to  place  a  narrow  board 
beneath  the  lower  sash  so  as  to  raise  its  upper  edge 
above  the  level  of  the  bottom  of  the  upper  sash  and 
form  an  opening  between  the  two  sashes,  through  which 
the  air  may  enter  (Fig.  7). 
By  this  arrangement  the  en- 
tering current  of  air  is  also 
deflected  upward  toward  the 
ceiling.  The  same  results 
may  also  be  obtained  by 
means  of  a  louver  placed  in 
the  lowest  pane  of  the  upper 
sash;  or  by  placing  a  mov- 
able glass  disk,  perforated 
with  holes,  over  one  of  the 
panes,  which  is  perforated 
in  a  similar  manner,  when 
by  rotating  the  disk  com- 
munication can  be  made 
with  the  outside  air  when- 
ever desired. 

Inlet  openings  in  the  walls 


\-»»=^.^„-  - 

— — =_ 

r  : 

1  g-    -     — - — - 

_____ 

l!JII 
1 

1 

ft 

§ 



! 

::.-: 

— -^ 

al 

a_j 

- 

— 

H^ 

Fig.  7. — Window  ventilator. 


to  utilize  the  perflating   action    of    the   wind    may    be 
either  direct  openings  through  the  walls  by  means  of 


68 


VENTILATION. 


air  bricks,  or  by  means  of  valved  openings,  as  the  Sher- 
ringham  valve,  in  which,  instead  of  the  air  brick,  an  iron 
frame,  containing  a  movable  plate  or  valve  on  its  inner 
surface,  is  inserted  into  the  opening.  When  the  valve  is 
open,  it  directs  the  current  of  air  upward  toward  the 
ceiling.  It  is  easily  closed  through  the  action  of  a  well- 
balanced  weight  suspended  to  it.  These  latter  arrange- 
ments are  frequently  employed  in  connection  with  what 
is  known  as  the  direct-indirect  system  of  heating  (Fig.  8). 


Fig.  8. — Wall  air  inlet. 


Fig. 


-Cowl. 


Perflation  may  be  aided  by  means  of  cowls  attached 
to  the  tops  of  chimneys  and  ventilating  shafts.  These 
are  composed  of  two  tubes,  one  within  the  other, 
having  a  hooded  cover  with  one  large  opening,  at  right 
angles  to  the  mouth  of  the  chimney,  which  is  turned 
toward  the  point  from  which  the  wind  is  coming  and 
directs  its  current  downward  through  one  of  the  tubes. 
They  may  be  either  movable  or  fixed;  the  latter  being 


ARRANGEMENTS  IN  NA  TURAL   VENTILA  TION.    69 


the  preferable  form,  because  it  is  less  liable  to  get  out  of 
order.  The  best  form  of  cowl  consists  of  a  fixed  down- 
cast tube  with  expanded,  trumpet-shaped  mouth,  above 
which  is  a  conical  cap,  the  apex  of  which  is  turned 
upward  (Fig.    9).      By    means  of  this   arrangement    the 


Fig.  10.— Air  introduced  at  bottom,  discharged  at  top. 

aspirating  force  of  the  wind  may  be  utilized  to  main- 
tain a  fairly  constant  current  of  air  either  in  one 
direction  or  the  other. 

The  movement  produced  by  the  unequal  weights  of 
masses  of  air  of  different  temperatures  takes  place  through 


Fig.  II. — Air  introduced  on  side,  discharged  at  top. 

the  ordinary  openings,  and  to  some  extent  through  the  por- 
ous walls  of  a  room;  but,  as  the  doors  and  windows  may  be 
closed  and  the  movement  be  largely  arrested,  other  open- 
ings should  be  provided  to  secure  ventilation.  The 
'problem  to  be  solved  is — Which  is  the  most  satisfactory 


70 


VENTILATION. 


method  of  forming  an  outlet  through  which  the  vitiated 
air  of  an  enclosed  space  may  readily  escape,  and  an  inlet 
through  which  the  fresh  outside  air  may  enter  without 
causing  a  perceptible  draught  ?  The  expired  air  of  human 
beings  is  warmed  to  within  about  one  deeree  centigrade 


Fig.  12. — Air  introduced  on  side,  discharged  on  opposite  side. 

of  the  body  temperature,  and  consequently  it  rises  into 
the  upper  part  of  the  enclosed  space.  The  air  surround- 
ing the  bodies  of  the  occupants  is  also  warmed  to  some 
extent,  and  rises  into  the  upper  part  of  the  space.  These 
facts  indicate  that  the  proper  place  for  the  outlet  openings 


Fig.  13. — Air  admitted  on  side,  discharged  near  bottom. 


is  in  or  near  the  ceiling.  If  artificial  lighting  is  used, 
the  air  is  heated  as  the  result  of  the  combustion  and  rises 
into  the  upper  part  of  the  space.  This  fact  also  indi- 
cates that  the  outlet  openings  should  be  placed  in  or  near 
the  ceiling,  so  as  to  allow  air  vitiated  in  this  manner  to 


ARRANGEMENTS  IN  NATURAL   VENTILATION.    71 


escape  as  freely  as  possible,  and  to  prevent  it  from  ming- 
ling with  the  air  that  is  to  be  respired. 

With  the  outlet  openings  at  the  top  of  the  enclosed 
space,  the  inlet  openings  should  be  at  a  lower  level,  pref- 


FlG.  14. — Air  admitted  at  bottom,  discharged  near  bottom. 


erably  as  near  the  floor  as  possible,  in  order  to  secure  the 
greatest  advantage  possible  from  differences  in  density  of 
masses  of  air,  by  making  the  height  of  the  column  of 
heated  air  as  great  as  possible.  A  current  of  cold  air 
introduced  at  the  level  of  the  feet  of  the  occupants 
would  be  unbearable,  and  various  plans  have  been  devised 


Fig.  15. — Inlet  near  top,  discharge  near  bottom. 

to  obviate  this  difficulty,  but  in  practice  none  of  them 
has  proved  entirely  satisfactory. 

Some  experiments  were  made  by  Mr.  Warren  R.  Briggs, 
of    Bridgeport,    Conn.,1    on    the   subject    of    the   proper 

1  Carpenter's  Heating  and  Ventilation  of  Buildings,  p.  46. 


7  2  I  EN  TIL  A  TION. 

method  of  introducing  pure  air  into  rooms,  and  the  best 
location  for  the  inlet  and  outlet.  The  experiments  were 
conducted  with  a  model  having  about  one-sixth  the 
capacity  of  a  school-room  to  which  the  perfected  system 
was  to  be  applied.  The  movements  of  the  air  in  the 
model  of  the  building  were  made  visible  by  mingling 
the  inflowing  air-stream  with  smoke,  which  rendered  all 
the  changes  undergone  by  it  in  its  passage  apparent  to 
the  eye. 

The  results  of  the  experiments  are  shown  graphically 
in  Figs.  10  to  15.  In  each  case  the  distribution  of  the 
fresh  air  is  indicated  by  the  curved  lines  of  shading.  A 
study  of  these  sketches  is  very  suggestive,  as  it  indicates 
the  best  results  when  the  inlet  is  on  the  side  near  the 
top,  and  the  outlet  is  in  the  bottom  and  near  the  center 
of  the  room.  The  tendency  of  the  entering  air  to  form 
air-currents  or  draughts,  which  in  some  instances  tend  to 
pass  out  without  perfect  diffusion,  is  well  shown.  This 
tendency  is  less  as  the  velocity  of  the  entering  air  is 
reduced,  and  we  probably  get  nearly  perfect  diffusion  in 
every  case  where  the  outlet  is  well  below  that  of  the 
inlet,  provided  the  velocity  of  the  entering  air  is  small — 
less  than  1.2  meters  per  second. 

In  order  to  prevent  the  production  of  draughts  in  the 
ventilation  of  rooms,  the  movement  of  the  incoming  air 
must  be  slow  and  gentle,  it  must  be  agreeable  in  tempera- 
ture, and  its  humidity  must  not  be  too  great  nor  too  low. 
The  conditions  which  cause  draught  are  (1)  too  great 
rapidity  of  current,  (2)  too  low  a  temperature,  (3)  exces- 
sive or  (4)  insufficient  humidity  of  the  air.  The  current 
of  air  should  be  broken  up  as  much  as  possible  by  sub- 
dividing the  openings  of  both  inlets  and  outlets,  espe- 
cially the  inlet  openings. 

The  fresh  air  should  be  obtained  from  a  pure  source;  if 
necessary,  it  should  be  washed  or  filtered  to  remove  dust 
and  soot;  if  it  is  brought  in  through  tubes,  these  should 
be  as  short  as  possible  and  easily  cleaned.  It  is  prefer- 
able to  brins:  in  fresh  air  through  numerous  small  open- 


ARRANGEMENTS  IN  NATURAL    VENTILATION.    7$ 

ings  than  through  a  few  large  ones.  In  cities  the  intake 
should  be  raised  above  the  surface  of  the  ground  some 
distance,  so  as  to  avoid  the  dust  of  the  streets. 

With  regard  to  the  size  of  inlets  and  outlets,  the  condi- 
tions of  temperature  are  so  variable  that  it  would  be  im- 
possible to  fix  a  size  that  would  be  universally  applicable. 
As  an  average  for  this  country,  a  size  of  156  square  cen- 
timeters per  head  for  inlet,  and  the  same  for  outlet, 
seems  calculated  to  meet  common  conditions;  but  arrange- 
ment should  be  made  for  enabling  this  to  be  lessened  in 
very  cold  weather,  or  if  the  influence  of  very  strong 
winds  is  felt.     Each  opening  should  not  be  larger  than 


Fig.  16. — Portable  anemometer. 

300  to  400  square  centimeters.  Air  expands  on  being 
warmed,  but  it  is  unnecessary  to  have  a  larger  outlet  area 
than  the  inlet  area;  indeed,  one  of  the  best  ways  of  pre- 
venting draught  is  to  ensure  greater  facility  for  entrance 
than  for  exit  of  the  air.  The  shape  of  the  opening  of 
the  inlet  or  outlet  tube  that  causes  least  friction  is  the 
circular,  inasmuch  as  the  area  is  larger  in  proportion  to 
the  periphery  than  that  of  any  other  figure. 

Friction. — Some  degree  of  friction  is  inevitable,  and  a 
deduction  of  one-fourth  should  be  made  in  every  case  on 
this  account.     In  addition  to  this,  a  further  loss  of  ve- 


74  VENTILA  TION. 

locity  arises  from  the  following  causes:  Size  of  the  open- 
ing, shape  of  the  opening,  length  of  the  shaft,  angles  in 
the  shaft,  and  the  presence  of  dirt. 

The  velocity  of  the  air-current  is  readily  determined 
by  means  of  an  anemometer  (Fig.  16).  If  we  know  the 
size  of  the  ventilating  shaft  and  the  velocity  of  the  air- 
current,  we  can  readily  ascertain  the  amount  of  fresh  air 
supplied. 

Artificial  Ventilation. — By  artificial  ventilation  is 
meant  that  form  of  ventilation  in  which  movement  of 
air  is  produced  by  means  of  artificial  contrivances.  These 
are,  broadly,  of  two  kinds:  Heat  and  mechanical  means, 
and  either  of  these  may  be  arranged  for  extraction  of 
foul  air  or  propulsion  of  fresh  air;  the  former  being 
sometimes  called  the  vacuum,  the  latter  the  plenum 
system. 

Heat. — In  practice  heat  is  employed  only  as  a  means  of 
ventilation  by  extraction,  not  by  propulsion.  The  more 
common  application  of  heat  in  artificial  ventilation  is  in 
the  extraction  of  air  from  a  room  by  means  of  the  ordi- 
nary open  fireplaces  and  chimneys.  This  action  depends 
on  the  principle  already  treated  of  under  natural  ventila- 
tion— that  of  expansion  of  masses  of  heated  air  causing 
the  production  of  upward  currents. 

The  rate  of  flow  up  an  ordinary  chimney  varies  from  i 
to  2  meters  per  second.  Taking  the  ordinary  size  of  a 
flue  as  24  by  36  centimeters,  it  is  seen  that  the  discharge 
varies  between  310  and  620  cubic  meters,  a  quantity 
sufficient  for  3  to  6  persons.  The  movement  will  be  to- 
ward the  fire  from  all  the  openings  in  the  room,  which, 
if  the  fire  burn  briskly,  are  converted  into  inlet  openings. 
The  larger  the  fireplace  and  the  fire  the  greater  the  ex- 
tractive force. 

A  heated  column  of  air  may  also  be  produced  by  coils 
of  hot-water  pipes  or  steam  pipes,  or  by  gas-burners  in  a 
ventilating  shaft.  Whatever  be  the  source  of  heat,  it  is 
best  to  place  it  at  the  bottom  of  the  shaft,  and  not  at  the 
top.     In  places  where  a  central  lighting  arrangement  is 


ARTIFICIAL    VENTILATION. 


75 


adopted,  as  in  the  auditorium  of  theaters,  advantage  may 
be  taken  of  the  heat  given  off  by  the  illuminating  agent 
to  carry  off  the  impure  air  through  a  shaft  placed  above 
the  chandelier. 

The  great  disadvantage  of  extraction  by  heat  is  its 
irregularity  of  action.  It  is  almost  impossible  to  regu- 
late the  temperature  of  the  column  of  heated  air,  conse- 
quently the  upward  current  will  sometimes  be  far  more 
rapid  than  at  other  times.  It  is  also  costly  on  a  large 
scale.  Nevertheless,  the  ventilating  power  of  the  com- 
mon open  fireplace  is  so  considerable  that  it  forms  an  im- 
portant argument  in  favor  of  this  method  of  ventilation. 

Mechanical  Means. — These  are  chiefly  fans,  pumps, 
and  jets.     Fans  are  almost  always  rotary,  and  may  be 


Fig.  17. — Air  propeller,  with  electric  motor  attached. 


either  centrifugal  (Fig.  1 7)  or  axial.  The  efficiency  of  a  fan 
is  estimated  in  terms  of  the  volume,  velocity,  and  pressure 
of  the  induced  air-current,  compared  with  the  horse-power 
required  to  produce  it.  Axial  fans  are  more  suitable 
where  a  large  volume  at  low  pressure  and  velocity  is  re- 


;6  VENTILA  TION. 

quired;  centrifugal  fans,  for  the  production  of  high  ve- 
locity and  high  pressure.  A  large  fan  worked  at  low 
speed  is  more  economical  than  a  small  one  at  high  speed. 
The  blades  are  best  curved  iu  centrifugal,  flat  and  in- 
clined in  axial,  fans.  Fans  can  be  used  either  for  extrac- 
tion or  propulsion;  they  may  be  worked  by  steam,  wind, 
water,  or  electric  power.  The  amount  of  air  delivered 
can  be  calculated  by  taking  the  velocity  of  revolution  of 
the  extremities  of  the  fan;  three- fourths  of  this  equals 
the  velocity  of  the  air,  this  allowance  being  necessary 
on  account  of  friction.  The  sectional  area  of  the  con- 
duit being  known,  the  delivery  per  second  can  be  calcu- 
lated from  these  data. 

Pumps  are  employed  in  the  ventilation  of  mines,  and 
may  be  used  either  for  forcing  in  fresh  air  or  extracting 
foul  air.  They  are  seldom  employed  in  the  ventilation 
of  buildings. 

Jets  for  producing  currents  of  air  are  of  three  kinds — 
steam,  compressed  air,  and  water.  Their  efficiency  de- 
pends principally  upon  the  degree  of  pressure  at  which 
the  jets  issue  from  the  nozzle.  All  jets  are  apt  to  be 
noisy,  compressed  air  being  least  so.  They  can  be  used 
either  for  extraction  or  propulsion;  in  the  latter  case  the 
steam  jet  will  moisten  the  incoming  air  considerably, 
which  may  be  either  an  advantage  or  the  reverse. 

.  There  are  certain  points  that  require  attention  in  all 
arrangements  for  artificial  ventilation: 

(i)  The  point  of  intake  for  the  fresh  air  should  be 
selected  principally  for  the  purity  of  the  air  obtained, 
and,  as  a  general  rule,  the  purest  air  will  be  found  at  a 
height  of  3  to  4.5  meters  (10  to  15  feet)  from  the  ground. 

(2)  The  air  may  require  cleansing  or  filtering.  With 
this  object  in  view  it  may  be  made  to  impinge  on  a  sheet 
of  still  water,  or,  better,  a  film  of  glycerin,  which  retains 
impurities  better  and  does  not  evaporate  so  readily. 
The  air  may  be  filtered  through  coarse  cloth,  or  cotton; 
the  latter  being  most  effective,  but  is  expensive  and  re- 
quires frequent  renewal.     A  thickness  of  about  1.4  deci- 


ARTIFICIAL    VENTILATION.  J  J 

meters  (6  inches)  may  be  employed.  The  air  may  also  be 
purified  by  washing  it  by  means  of  a  spray  or  passing  it 
through  a  wire  screen  over  which  a  fine  stream  of  water 
is  running.  This  adds  moisture  to  the  air  and  may  re- 
quire supervision,  as  a  hot,  moist  air  produces  languor. 

(3)  The  temperature  of  the  incoming  air  should  be 
regulated.  It  may  be  cooled  in  summer  by  passing  over 
ice,  or,  if  the  water  spray  is  used,  this  may  be  cooled  by 
ice,  which  is  an  effective  method  of  reducing  the  tem- 
perature. An  apparatus  devised  by  Professor  Gates,  of 
Washington,  for  the  cooling  of  rooms  in  summer,  can  be 
more  cheaply  operated  than  a  coal  stove  in  winter,  It  is 
simply  a  tall  cylinder  of  galvanized  iron  resting  in  a  large 
basin  or  pan,  and  connecting  at  the  top  with  the  ordinary 
stove  pipe  or  with  a  tube  leading  out  of  a  window.  In 
the  top  of  the  cylinder's  interior  is  a  perforated  tubular 
ring,  and  on  a  cock  being  turned  on  this  ring  an  artificial 
shower  is  produced  inside  the  cylinder.  The  water  thus 
flowing  down  the  sides  takes  on  a  rapid  spiral  motion 
which  sucks  the  air  down  the  cylinder  at  a  rapid  rate; 
the  fine  spray  inside  cooling  the  air,  reducing  its  hu- 
midity to  normal,  and  purifying  it  of  all  dust  and  odor. 
The  water  collects  in  a  basin  below,  from  which  it  is 
drained  off,  the  cool  air  escaping  through  openings  just 
above  the  water  surface  of  the  basin.  In  some  experi- 
ments made  with  this  apparatus  the  temperature  of  the 
air  on  entering  the  cooling  cylinder  was  observed  to  be 
330  C,  while  it  was  20°  C.  on  taking  its  exit  at  the 
bottom.  Recently  liquid  air  has  been  introduced  as  a 
means  of  cooling  the  air  in  summer,  and  has  been  applied 
with  satisfaction  in  the  ventilation  of  theaters. 

The  incoming  air  may  be  warmed  by  passing  over  or 
through  a  heating  apparatus,  such  as  hot-water  or  steam 
pipes.  This  is  the  method  now  commonly  employed  in 
the  ventilation  of  large  buildings.  The  whole  of  the 
air-supply,  in  a  scheme  of  artificial  ventilation,  ought  to 
be  admitted  to  the  chamber  to  be  ventilated  at  the 
required  temperature,  and  no  attempt  should  be  made  to 


78  VENTILA  TION. 

warm  the  room  by  superheated  air.  As  a  rule,  the  fresh 
air  should  be  warmed  as  near  as  possible  to  the  tempera- 
ture desired  in  the  room.  In  large  buildings,  consisting 
of  many  rooms,  the  scheme  of  ventilation  requires  sepa- 
rate and  perhaps  different  arrangements  in  different  parts. 
In  other  buildings,  such  as  churches  and  theaters,  a 
single  central  scheme  is  preferable. 

(4)  The  channels  through  which  the  air  is  conducted 
should  be  so  arranged  as  to  be  easily  cleansed;  this  is 
especially  necessary  in  propulsion  methods,  and  inatten- 
tion to  this  point  has  in  many  instances  brought  the 
method  into  bad  repute.  Where  the  air  has  been  pre- 
viously filtered  there  will,  of  course,  be  less  deposit  of 
dirt  on  the  sides  of  the  inlet  shafts.  Extraction  shafts 
also  require  to  be  kept  clean. 

(5)  There  are  four  conditions  that  cause  the  sensation 
of  draught:  Too  great  rapidity  of  the  air  current;  too 
low  a  temperature;  too  great  humidity;  too  low  humidity. 
These  four  factors  must  always  be  borne  in  mind  in 
examining  into  the  cause  of  draught. 

The  inlet  and  outlet  openings  must  be  so  placed  that  a 
thorough  aeration  of  the  room  is  possible  without  the 
production  of  draughts.  Different  arrangements  are 
required  for  the  inlet  and  outlet  openings  for  winter  and 
summer.  In  summer  the  cool  air  is  brought  in  at  a 
height  of  from  2  to  3  meters  above  the  floor  in  such  a 
manner  that  it  is  conducted  toward  the  ceiling.  From 
this  point  it  sinks  gradually,  and  when  warmed  rises  and 
takes  its  exit  at  the  opposite  side  of  the  room  near  the 
ceiling.     In  winter  the  air  takes  its  exit  near  the  floor. 

The  system  of  ventilation  should  be  so  constructed 
that  it  can  be  regulated  to  meet  all  reasonable  require- 
ments as  to  quantity  of  air  furnished  and  the  temperature 
that  may  be  demanded  \>y  atmospheric  conditions. 

Removal  of  Dust. — The  removal  of  dust  in  manu- 
facturing establishments  requires  special  arrangements. 
The  rates  of  interchange  of  air  occurring  in  closed  rooms 
are  insufficient  to  keep  the  dust  moving,  and  much  less 


REMOVAL  OF  DUST. 


79 


to  remove  it.  Where  large  quantities  of  dust  are  pro- 
duced, as  in  certain  manufactories,  it  is  possible  to  apply 
strong  air  currents  only  in  the  vicinity  of  the  source  of 
the  dust  in  order  to  aspirate  it,  as  in  the  case  of  circular 
saws  and  grindstones  (Figs.  18,  19,  20).  Where  the  dust 
cannot  be  satisfactorily  removed  by  means   of   such   a 


Fig.  18. — Apparatus  for  removing  dust  in  manufacturing  establishments: 
a,  inlet  to  exhaust  shaft ;  b,  valve  regulating  spray ;  c,  water-supply  pipe ;  </, 
outlet  of  exhaust  shaft. 


method  it  is  often  possible  to  modify  the  manufactur- 
ing process  in  such  a  manner  as  to  prevent  excessive 
dust  formation.  This  is  frequently  accomplished  by 
the  use  of  a  spray  of  water  so  as  to  render  the  material 
damp  and  thus  prevent,  in  large  part,  the  formation  of 
dust. 

In  houses  and  hospitals  dust  is  to  be  prevented  from 
forming  as  much  as  possible.  If  dust  has  formed,  it 
tends    to  settle  upon   horizontal  surfaces  if  there  is    an 


8o 


VENTILA  TION. 


FlG.  19. — Apparatus  for  removing  dust  in  manufacturing  establishments : 
a,  emery  weeel ;   b,  hood  over  emery  wheel ;   c,  exhaust  shaft. 

absence  of  air  currents,  from  which  it  may  be  removed 
by  means  of  a  damp  cloth. 


Fig.  20. — Apparatus  for  removing  dust  in  manufacturing  establishments 
a,  blower;  b,  dust-collecting  chamber;  c,  water-sprays. 


REMOVAL  OF, DUST.  8 1 

Comparison  of    Extraction  and    Propulsion  Methods 

The  extraction  method  is  less  costly  and  utilizes  the 
naturally  high  temperature  of  the  vitiated  air  to  assist  in 
the  ventilation.  Its  disadvantages  are  that  the  source  of 
the  incoming  air  is  not  under  control,  and,  consequently, 
impure  air  may  be  admitted  and  there  is  greater  liability 
to  draught.  In  the  propulsion  method  the  inlets  are 
entirely  under  control  if  properly  arranged,  and  the 
purity  of  the  air  can  be  assured,  as  well  as  its  suitable 
temperature  and  velocity,  so  as  to  avoid  draughts.  A 
proper  diffusion  of  the  incoming  air  throughout  the  room 
is  more  easily  effected  in  the  propulsion  than  in  the  ex- 
traction method.  The  disadvantage  of  propulsion  is  its 
greater  cost.  A  combination  of  the  two  methods  is  fre- 
quently employed,  and  meets  all  the  requirements. 

Comparison  of    Natural    and    Artificial    Methods (i) 

Natural  ventilation  is  rarely  sufficient,  and  requires  to  be 
supplemented  in  order  to  obtain  efficient  ventilation.  (2) 
For  dwellings,  extraction  by  heat  by  means  of  open  fire- 
places and  chimney  is  generally  sufficient.  It  is  auto- 
matic and  requires  no  special  attention,  but  it  is  not  a 
perfect  system  of  ventilation.  (3)  For  large  halls, 
churches,  theaters,  and  schools  artificial  ventilation  is 
necessary.  In  buildings  of  this  character  mechanical 
methods  have  a  decided  advantage  over  natural  ventila- 
tion, not  only  in  the  purity  of  the  air,  but  in  the  more 
equable  temperature  attainable. 


CHAPTER  III. 
HEATING. 

Heating  must  always  be  considered  in  connection 
with  ventilation.  This  is  necessary  for  several  reasons. 
The  combustion  of  coal  utilizes  oxygen,  and  as  a  result 
the  products  of  combustion  are  given  off.  In  order  to 
supply  air  for  combustion  and  draught  fresh  air  must  be 
introduced.  It  is  also  necessary  to  have  a  supply  of  fresh 
air  to  replace  the  heated  air  which  escapes  from  the 
building. 

I/OSS  of  Heat  from  Buildings. — Heat  is  required  to 
warm  the  air  of  a  room  to  a  given  temperature,  to  supply 
the  loss  of  the  heat  from  radiation  and  conduction  from 
the  windows  and  walls,  and  to  supply  the  heat  for  the  air 
required  for  ventilation.  The  amount  of  heat  required 
for  these  various  purposes  will  depend  largely  upon  the 
construction  of  the  building,  the  amount  needed  for  pur- 
poses of  ventilation,  and  the  difference  between  the 
inside  and  outside  temperature.  The  loss  of  heat  from 
the  walls  of  buildings  depends  upon  the  material  used, 
its  thickness,  the  number  of  layers,  the  difference  between 
the  temperature  of  outside  and  inside  surfaces,  and  the 
air  exposure.  For  ordinary  temperatures  and  pressures 
about  i  cubic  meter  of  air  will  absorb  i  calorie  in  being 
warmed  i  degree  C. ,  and  hence  can  be  considered  the 
equivalent  of  i  kilogram  of  water.  The  number  of 
calories  required  for  ventilation  can  then  be  found  by 
multiplying  the  number  of  cubic  meters  of  air  by  the 
difference  between  the  inside  and  outside  temperature, 
and  this  product  by  the  number  of  times  the  air  is 
changed  in  an  hour. 

Degree  of  Warmth. — The  temperature  most  suitable 


HE  A  T  SUPPLIED  B  Y  RAD  I  A  TING  SURFACES.    83 

for  healthy  persons  ranges  from  170  to  200  C.  for  living 
rooms,  and  150  to  180  C.  for  bed-rooms.  For  children 
and  aged  persons  a  somewhat  higher  temperature  is 
required.  No  standard  temperature  can  be  named, 
because  a  temperature  just  comfortable  for  one  person 
may  be  too  warm  or  too  cold  for  others.  Custom  and 
occupation  have  a  great  influence  in  deciding  the  matter. 
Heat  Supplied  by  Radiating  Surfaces.— The  heat 
used  in  warming  is  obtained  either  by  directly  placing  a 
heated  surface  in  the  apartment,  in  which  case  the  heat 


Fig.  21. — Arrangement  of  indirect  heating  surface. 


is  said  to  be  obtained  by  direct  radiation,  or  else  by  heat- 
ing the  air  which  is  to  be  used  for  ventilating  purposes 
while  passing  to  the  room,  in  which  case  the  heating  is 
said  to  be  by  indirect  radiation  (Fig.  21). 

Direct  heating  is  performed  by  locating  the  heated  sur- 
face directly  in  the  room,  and  this  surface  may  be  heated 
directly  by  fire,  as  is  the  case  with  stoves  and  fireplaces, 
or  it  may  receive  its  heat  from  steam  or  hot  water 
warmed  in  some  other  portion  of  the  premises  and  con- 
veyed in  pipes.     The  general  principles  of  heating  are 


84  HE  A  TING. 

the  same  in  each  case,  but  in  the  case  of  stoves  the  tem- 
perature is  greatly  in  excess  of  that  derived  from  steam 
or  hot-water  radiators.  The  heat  is  carried  away  from 
the  heated  surface  partly  by  radiation,  in  which  case 
the  heat  passes  in  straight  lines  in  all  directions  and  is 
absorbed  by  the  bodies  of  persons,  by  the  furniture  and 
walls  of  the  room,  without  warming  the  intervening  air 
directly.  The  heat  is  also  carried  away  by  particles  of 
air  coming  in  contact  with  the  heated  surface — that  is, 
by  convection — which  may  be  the  radiating  surface,  the 
bodies  of  persons,  or  the  furniture  and  walls  of  the  room 
which  have  been  warmed  by  the  radiant  heat. 

The  sensation  produced  by  radiant  and  convected  heat 
is  quite  different.  The  radiant  heat  has  the  effect  of  in- 
tensely heating  on  the  side  toward  the  source  of  heat, 
and  producing  no  warming  effect  whatever  on  the  oppo- 
site side.  The  heat  which  has  passed  off  by  convection 
is  first  utilized  in  warming  the  air,  and  the  sensation  pro- 
duced is  that  of  heat  of  lower  temperature  equably  dis- 
tributed. Radiant  and  convected  heat  is  essentially  of 
the  same  nature;  in  the  one  case  it  is  derived  directly 
from  the  source  of  heat,  and  at  a  high  temperature;  in 
the  other  case  it  is  received  from  the  air,  which  is  at  a 
comparatively  low  temperature. 

Resistance  to  Radiation. — The  heat  in  passing  through 
any  metallic  surface  raises  its  temperature  to  an  extent 
which  depends  upon  the  facility  with  which  heat  is  con- 
ducted by  the  body  and  discharged  from  the  other  sur- 
face. It  is  noted  that  heat  meets  with  three  distinct 
classes  of  resistance  in  passing  through  a  metallic  sub- 
stance: First,  that  due  to  the  inner  surface;  second,  that 
due  to  the  thickness  of  the  material ;  and  third,  that  due 
to  the  outer  surface.  The  first  and  third  resistances  are 
due  to  change  in  media,  and,  when  the  material  under 
consideration  is  a  good  conductor,  constitute  the  principal 
portion  of  the  resistance  to  the  passage  of  the  heat 

Heat  Emitted  by  Radiation. — Heat  emitted  by  radiation, 
per  unit  of  surface  and  unit  of  time,  is  independent  of 


SYSTEMS  OF  HE  A  TING.  85 

the  form  and  extent  of  the  heated  body,  provided  there 
are  no  re-entrant  surfaces  which  intercept  rays  of  radiant 
heat.  The  amount  of  heat  projected  from  a  surface  of 
such  form  as  to  radiate  heat  equally  in  all  directions  de- 
pends only  on  the  nature  of  the  surface,  the  excess  of  its 
temperature  over  that  of  the  surrounding  air,  and  the 
absolute  value  of  its  temperature.  The  rate  of  cooling 
due  to  radiation  is  the  same  for  all  bodies,  but  its  absolute 
value  varies  with  the  nature  of  the  surface.  The  con- 
struction of  the  ordinary  form  of  radiator  is  such  as  to 
present  very  little  free  radiating  surface,  as  all  the  heat 
which  impinges  from  one  tube  to  another  is  radiated 
back,  and  is  consequently  not  used  in  heating  the  apart- 
ment. The  greater  portion  of  the  heat  removed  is,  no 
doubt,  absorbed  by  the  air  which  comes  in  contact  with 
the  surface,  or  by  convection.  The  heat  removed  by 
convection  is  independent  of  the  nature  of  the  surface  of 
the  heated  body  and  the  surrounding  absolute  tempera- 
ture. It  depends  on  the  velocity  of  the  moving  air,  and 
is  thought  to  vary  with  the  square  root  of  the  velocity. 
It  also  depends  on  the  form  and  dimensions  of  the  heated 
body,  and  on  the  excess  of  its  temperature  over  that  of 
the  surrounding  air. 

Systems  of  Heating-. — There  are  three  systems  of 
heating  in  common  use: 

(1)  Direct  radiation,  where  the  heating  surface  is  in 
the  room,  as  a  stove,  steam  coil,  or  open  fireplace.  The 
heat  rays  from  an  open  fireplace  are  radiant.  They  do 
not  warm  the  air  directly.  Heat  from  a  moderately  hot 
stove  or  from  a  steam  coil  is  very  little  radiant.  The 
particles  of  air  are  heated  and  brought  into  circulation — 
heating  by  convection.  This  is  the  cheapest  and  does 
not  waste  any  air. 

(2)  Indirect  radiation,  where  the  heating  surface  is  not 
in  the  room  heated,  but  in  some  other  portion  of  the 
premises,  such  as  furnace  heating  by  flues.  It  is  impos- 
sible to  heat  by  indirect  radiation  without  bringing  more 
or  less  air  into  the  room.    It  necessitates  some  ventilation. 


86  HE  A  TING. 

It  is  always  more  costly  than  direct  radiation,  but  is 
usually  more  satisfactory  and  less  troublesome. 

(3)  Direct-indirect  radiation,  where  the  heating  surface 
is  in  the  room,  but  has  air  coming  from  the  outside  at  the 
same  time,  and  is  so  arranged  that  the  supply  of  outside 
air  can  be  cut  off,  converting  it  into  direct  radiation. 

Direct  Radiation. — Open  Fireplaces. — With  open  fire- 
places the  heating  is  almost  entirely  by  radiation,  as 
there  is  very  little  opportunity  for  convection  of  heat. 
Its  advantages  are  limited  though  important.  It  adds 
little  of  the  impurities  of  combustion  to  the  air  of  a 
room,  and  it  insures  the  extraction  of  considerable 
amounts  of  the  room  air  and  its  replacement  by  fresh 
outside  air.  The  objections  to  this  mode  of  heating  are 
that  a  very  large  proportion  of  the  heat  is  lost,  and  the 
portion  utilized  is  only  given  off  as  radiant  heat,  thus 
warming  only  one  side  of  the  body  while  the  opposite 
side  remains  cold.  It  is  also  productive  of  cold  draughts, 
because  the  cold  outside  air  always  tends  to  flow  directly 
toward  the  fireplace.  The  heating  is  inconstant  on 
account  of  changes  in  the  direction  of  the  wind,  and  at 
times  the  rooms  are  smoky  from  this  cause.  This  method 
of  heating  is  of  greatest  importance  as  an  adjunct  to 
other  systems,  such  as  the  heating  of  the  wards  of  a 
hospital  where  an  open  fireplace  is  quite  cheerful  when 
the  system  of  heating  is  by  means  of  hot  air  or  by  steam. 

Stoves. — The  principal  advantages  of  stoves  are  that  a 
considerable  amount  of  the  heat  generated  is  utilized,  and 
the  heating  is  more  under  direct  control  and  supervision. 
Its  advantages  are  that  it  tends  to  dry  the  air,  and  it 
affords  no  means,  as  a  rule,  for  introducing  fresh  air.  It 
is  objectionable  because  of  the  large  amount  of  dust 
which  it  produces. 

Steam  and  Hot=water  Radiators. — The  use  of  steam 
and  hot- water  radiators  involves  the  installation  of  a  gen- 
eral heating  system  of  which  the  radiators,  are  only  a 
small  part.  As  far  as  efficiency  of  heating  effects  are 
concerned,  there  is  very  little  preference  between  these 


DIRECT  RADIA  TION.  8  7 

two  methods.  The  hot-water  system  is  more  expensive 
to  introduce,  but  the  running  expenses  are  lower  than 
for  steam,  because  it  is  less  expensive  to  warm  the  water 
to  ioo°  C.  than  to  convert  it  into  steam  at  ioo°  C. 

Heating  by  Steam. — When  water  is  converted  into 
steam  537  calories  are  absorbed  or  rendered  latent ;  1 
kilogram  of  water  at  ioo°  C.  requires  as  much  heat  to 
convert  it  into  steam  at  ioo°  C.  as  would  raise  537  kilo- 
grams 1  degree  C. ,  or  1  kilogram  537  degrees  C.  This 
is  termed  the  latent  heat  of  steam,  and  in  condensing 
back  into  water  this  heat  is  given  off  and  can  be  utilized 
for  purposes  of  heating. 

Steam-heating  plants  are  either  high  or  low  pressure. 
High-pressure  systems  are  now  generally  called  expansive 
systems.  They  carry  steam  at  a  pressure  of  over  700 
grams  to  the  square  centimeter,  while  the  low-pressure 
systems  carry  steam  at  less  than  700  grams,  usually  from 
150  to  350  grams  to  the  square  centimeter.  The  low- 
pressure  systems  are  now  principally  used. 

Systems  of  Piping. — There  are  three  systems  of  piping 
in  use  :  (1)  The  two-pipe  system,  which  is  most  com- 
monly employed,  and  can  be  used  for  either  high-  or 
low-pressure  steam.  The  main  return  riser  is  carried 
below  the  water-line  of  the  boiler.  Various  modifica- 
tions of  this  system  are  in  use.  Each  radiator  is  pro- 
vided with  separate  flow  and  return  pipes.  (2)  A  partial- 
circuit  system,  in  which  the  main  flow  pipe  rises  to  the 
highest  part  of  the  basement  by  one  or  more  branches, 
whence  the  distributing  pipes  run  at  a  slight  incline,  and 
finally  connect  with  the  boiler  below  the  water-line.  The 
radiators  are  connected  by  risers  which  carry  both  flow 
and  return  from  and  to  the  distributing  pipes.  The 
pipes  must  be  made  large.  This  system  is  employed 
quite  extensively  in  private  houses.  (3)  The  complete- 
circuit  system,  often  called  the  one-pipe  system,  in  which 
the  main  pipe  is  led  directly  to  the  highest  part  of  the 
building  ;  thence  distributing  pipes  are  run  to  the  various 
return  risers,  which  in  turn  connect  with  the  radiating 


88  HE  A  TING. 

surface  and  discharge  in  the  main  return.  The  supply 
for  the  radiating  surface  is  all  taken  from  the  return 
risers,  and  in  some  cases  the  entire  downward  circulation 
passes  through  the  radiating  system. 

Exhaust=steam  Heating. —  This  does  not  imply  any 
particular  method  of  running  the  pipes,  but  proper  con- 
nections must  be  made  between  the  exhaust  and  the 
heating  pipes,  and  provision  must  be  made  for  taking 
care  of  the  condensed  water. 

Hot=water  Heating. — On  account  of  its  high  specific 
heat  water  is  able  to  store  up  heat,  which  it  afterward 
gives  up  to  the  air.  One  kilogram  of  water  in  cooling 
from  ioo°  C.  to  200  C.  gives  up  80  calories,  which  can 
heat  8  X4  =  32  kilograms  of  air  through  io°  C,  because 
the  specific  heat  of  air  is  only  one-fourth  that  of  water. 
Thirty-two  kilograms  of  air  are  equal  to  24.61  cubic 
meters. 

Methods  of  Piping. — A  system  of  hot-water  heating 
should  present  a  perfect  system  of  circulation  from  the 
heater  to  the  radiating  surface,  and  then  back  to  the 
heater  through  the  returns.  An  expansion  tank,  on  the 
top  floor,  must  be  provided  to  prevent  excessive  pressure 
due  to  the  heating  and  consequent  expansion  of  the 
water.  In  the  system  ordinarily  employed  for  hot-water 
heating  the  mains  and  distributing  pipe  have  an  inclina- 
tion upward  from  the  heater,  while  the  returns  are  par- 
allel to  the  main  and  have  an  inclination  downward 
toward  the  heater,  connecting  at  its  lowest  part.  In  this 
svstem  great  care  must  be  taken  to  produce  nearly  equal 
resistance  to  flow  in  all  the  branches  leading  to  the  dif- 
ferent radiators.  It  will  be  found  that  invariably  the 
principal  current  of  heated  water  will  be  the  path  of 
least  resistance,  and  that  a  small  obstruction,  as  any 
irregularity  in  the  piping,  is  sufficient  to  make  very  great 
differences  in  the  amount  of  heat  received  in  different 
parts  of  the  same  system. 

The  expansion  tank  must  in  every  case  be  connected 
to  a  line  of  piping  which  cannot  by  any  possible  means 


INDIRECT  RADIA  TION.  89 

be  shut  off  from  the  boiler.  It  does  not  seem  to  be  a 
matter  of  importance  whether  it  is  connected  with  the 
main  flow  or  the  return. 

Combination  Systems  of  Heating. —  Several  methods 
have  been  devised  for  using  the  same  system  of  piping 
alternately  for  steam  or  hot  water  as  the  demand  for 
higher  or  lower  temperature  might  change. 

Indirect  Radiation. — By  Means  of  Steam  Radiators. 
— Radiators  which  are  placed  in  a  passage  or  flue  which 
supplies  air  to  a  room  are  termed  indirect.  These 
heaters  are  made  in  various  forms.  They  should  be 
placed  in  a  chamber  or  box  as  nearly  as  possible  at  the 
foot  of  a  vertical  flue  leading  to  the  room  to  be  heated. 
Air  is  admitted  through  a  passage  from  the  outside  pro- 
vided with  suitable  dampers.  The  chamber  surrounding 
the  radiator  and  the  flue  leading  from  the  chamber  are 
constructed  of  masonry  or  of  galvanized  iron,  and  that 
supplying  the  cold  air  of  wood  lined  with  tin.  There 
should  be  a  door  into  the  chamber,  so  that  the  heater 
may  be  cleaned  when  necessary.  It  is  of  great  advantage 
to  have  a  by-pass  and  mixing  dampers  in  the  flues,  so 
that  the  heated  air  can  be  mixed  with  cold  air  in  order  to 
attain  the  desired  temperature  of  the  incoming  air.  These 
dampers  are  often  regulated  automatically  by  means  of 
thermoregulators,  whereby  the  desired  temperature  is 
maintained  by  mixing  requisite  amounts  of  heated  and 
cold  air. 

The  system  of  indirect  heating  by  means  of  steam 
radiators  in  stacks  is  now  very  generally  in  use  for  large 
buildings,  and  when  a  fan  is  used  to  propel  the  air 
through  the  building  affords  the  most  satisfactory  system 
of  ventilation  and  heating.  When  all  the  arrangements 
have  been  properly  made  the  requisite  amount  of  air  can 
be  forced  into  the  building  and  at  the  desired  temperature. 
In  comparison  with  the  efficiency  of  the  results  obtained 
in  ventilation  and  heating  with  this  system  the  cost  of 
the  system  is  no  great  objection. 

Heating  with  Hot  Air. — The  general  laws  which  apply 


90  HE  A  TING. 

to  hot-air  heating  have  already  been  considered  in  con- 
nection with  ventilation  and  the  indirect  methods  of 
heating.  The  outside  air  is  conducted  through  an 
outer  casing  surrounding  a  furnace,  and  when  heated 
rises  through  the  flues  and  passes  into  the  rooms  above. 
The  rapidity  of  the  circulation  depends  entirely  upon 
the  heat  of  the  furnace  and  the  height  of  the  flue 
through  which  it  passes.  In  order  that  the  circula- 
tion of  air  through  the  rooms  may  be  more  perfect, 
outlet  openings  must  be  provided  for  the  escape  of  the 
impure  air.  This  system  is  not  adapted  for  large  build- 
ings, because  the  horizontal  distance  to  which  heated  air 
will  travel  is  somewhat  limited.  When  properly  propor- 
tioned, in  buildings  of  moderate  size,  this  system  gives 
fairly  satisfactory  results. 

In  order  that  the  hot-air  system  may  be  satisfactory  in 
every  respect,  the  furnace  should  be  sufficiently  large, 
and  the  ratio  of  heating  surface  to  grate  such  that  a 
large  quantity  of  air  may  be  heated  to  a  low  degree, 
rather  than  a  small  quantity  to  a  high  degree  of 
temperature.  The  air-supply  of  the  furnace  is  usually 
derived  from  the  outside  through  a  shaft  specially  con- 
structed for  this  purpose,  though  in  many  private  dwell- 
ings the  air  is  drawn  immediatelv  from  the  basement. 
The  disagreeable  effects  of  the  air  of  furnace-heated 
rooms  are  due  to  the  dryness  of  the  air.  The  principal 
objection  to  furnace-heating  is  the  fact  that  when  the  sup- 
ply of  heat  is  shut  off,  the  supply  of  fresh  air  is  also  excluded. 

Heating  with  Electricity — Electrical  energy  can  be 
transformed  into  heat,  and  as  there  are  certain  advantages 
pertaining  to  its  ready  distribution,  it  is  likely  to  come 
into  more  general  use  for  heating.  One  watt  for  one 
hour,  which  is  the  ordinary  commercial  unit  for  elec- 
tricity, is  equal  to  3.41  calories.  Electricity  is  usually 
sold  on  the  basis  of  1000  watt-hours  (1  kilowatt)  as  a 
unit  of  measurement,  the  watts  being  the  product  ob- 
tained by  multiplying  the  amount  of  current  estimated 
in  amperes  by  the  pressure  or  intensity  estimated  in  volts; 


INDIRECT  RADIA  TION.  91 

on  this  basis  1000  watt-hours  are  equivalent  to  3410 
calories.  The  expense  of  electric  heating  must  in  every 
case  be  very  great,  unless  electricity  can  be  supplied  "at 
an  exceedingly  low  price. 

Heating  by  Means  of  Gas — In  many  towns  throughout 
the  natural  gas  region  gas  is  used  for  heating  as  well  as 
for  illuminating  purposes.  In  these  localities  gas  is  the 
cheapest  mode  of  heating.  It  is  employed  in  both  the 
direct  and  indirect  systems  of  heating.  When  suitable 
arrangements  are  made  for  carrying  off  the  products  of 
combustion,  and  there  is  a  proper  supply  of  fresh  air  for 
purposes  of  ventilation,  this  is  a  very  satisfactory  method 
of  heating.  In  cold  weather,  where  the  daily  fluctuations 
in  the  temperature  are  not  very  great,  the  gas  heater  can 
be  lighted  and  adjusted,  and  requires  practically  no  atten- 
tion for  weeks  or  even  months.  It  is  therefore  a  great 
saving  in  time  and  annoyance,  and  there  is  no  coal  to 
shovel  nor  ashes  to  remove. 

Heating  by  Means  of  Petroleum. — Within  recent  years 
petroleum  has  been  brought  into  common  use  for  heating 
purposes.  The  advantages  of  oil  heaters  are  that  they 
are  portable  and  may  be  carried  from  one  room  to  another, 
and  the  amount  of  heat  can  be  readily  controlled.  These 
petroleum  stoves  are  objectionable,  however,  from  the 
fact  that  the  combustion  of  the  petroleum  utilizes  large 
quantities  of  the  oxygen  of  the  air  of  the  room,  giving 
off  corresponding  amounts  of  carbon  dioxid.  Babuke l 
has  found  that  in  a  room  of  12  cubic  meters  capacity, 
during  the  first  hour  the  temperature  of  the  room  was 
raised  only  4  degrees  C. ,  and  rose  but  slowly  afterward. 
The  proportion  of  carbon  dioxid  in  the  air  of  the  room 
exceeded  1  part  per  1000,  and  reached  in  the  vicinity  of 
the  floor  3-10  parts  per  1000,  and  in  the  upper  part  of 
the  room  6-12  parts  per  1000,  amounts  which  would  be 
detrimental  to  health  when  inhaled .  constantly.  The 
amount  of  petroleum  consumed  was  about  a  liter  in 
eight  hours. 

1  Zeitschrift  f.  Hygiene.  Bd.  xxxii.,  S.  33. 


CHAPTER    IV. 
WATER    AND    WATER=SUPPLY. 

Physical  Properties  of  Water. — Pure  water  is  a 
colorless,  odorless,  and  tasteless  liquid,  of  neutral  reac- 
tion, and  is  taken  as  the  type  of  all  liquids,  as  air  is  the 
type  of  all  gases. 

Chemical  Composition. — Pure  water  consists  of  2 
parts  by  weight  of  hydrogen  and  16  parts  by  weight  of 
oxygen,  having  a  molecular  weight  of  18.  Two  volumes 
of  hydrogen  combine  with  1  volume  of  oxygen  to  form 
2  volumes  of  water  gas,  having  a  density  of  9.  The 
chemical  formula  for  water  is  H20.  The  percentage 
composition  of  water  is  hydrogen,  it. ii;  oxygen,  88.89. 

Chemically  pure  water  does  not  exist  in  nature,  but  is 
made  in  the  laboratory  by  mixing  the  required  amounts 
of  hydrogen  and  oxygen  gas  and  then  passing  an  electric 
current  through  the  mixture.  The  gases  unite  and  form 
water.  From  the  hygienic  standpoint,  water  as  found  in 
nature  is  either  pure  or  impure.  Hygienically  pure 
water  is  one  which  does  not  contain  any  foreign  matter 
which  is  injurious  to  health.  Impure  water  is  one  that 
is  unfit  for  domestic  use.  Water  as  it  exists  in  nature 
contains  a  great  variety  of  substances  derived  from  the 
air  through  which  it  has  fallen  as  rain  or  snow,  and  from 
the  soil  over  and  through  which  it  has  passed.  The 
nature  and  quantity  of  the  mineral  salts  dissolved  out  of 
the  soil  by  water  are  dependent  upon  the  chemical  com- 
position of  the  soil.  The  nature  and  amount  of  organic 
matter  contained  in  the  water  are  dependent  largely  upon 
the  nature  of  the  soil-covering  over  which  the  water  has 
passed. 

92 


SPRING-  WA  TER.  93 

Water  as  it  occurs  in  nature  niay  be  divided  into  rain- 
water, spring-,  river-,  lake-,  and  sea-water.  Each  of 
these  natural  waters  varies  somewhat  according  to  the 
locality  from  which  it  is  derived,  though  in  a  general 
way  all  of  these  natural  waters  possess  characteristics 
which  are  common  to  all  the  waters  of  that  particular 
class. 

Rain-water. — If  rain-water  were  collected  in  a  chemi- 
cally clean  vessel  at  the  moment  when  it  was  condensed, 
it  would  presumably  be  chemically  pure,  but  in  falling 
through  the  atmosphere  it  takes  up  some  of  the  impuri- 
ties in  the  air.  Rain-water  is  one  of  the  purest  of  the 
natural  waters,  but  it  varies  in  purity  with  the  nature  of 
the  atmosphere  through  which  it  has  fallen.  It  is  always 
purer  at  the  end  than  at  the  beginning  of  a  shower.  It 
contains  dissolved  gases  derived  from  the  atmosphere — 
on  an  average  25  cubic  centimeters  per  liter,  of  which 
about  64  per  cent,  is  nitrogen,  34  per  cent,  oxygen,  and 
2  per  cent,  carbon  dioxid.  The  relatively  large  amount 
of  carbon  dioxid,  in  comparison  with  the  proportion  con- 
tained in  atmospheric  air,  is  due  to  its  large  absorption 
coefficient.  Ammonia  is  also  commonly  present.  The 
average  amount  of  solid  matter  in  rain-water  is  39.5  parts 
per  1,000,000.  Sodium  chlorid  is  the  most  abundant 
salt,  while  nitric  acid  and  nitrates,  sulphuric  acid  and 
sulphates,  and  a  little  organic  matter  are  also  commonly 
present. 

Spring- water. — That  portion  of  the  rain-water  which 
penetrates  the  ground  exercises  a  powerful  chemical 
action  on  the  substances  present  in  the  soil  and  under- 
lying rocks.  This  action  consists  of  solution,  hydration, 
oxidation,  etc.  Rain-water  is  an  oxidizing  agent  on 
account  of  the  considerable  proportion  of  dissolved  oxy- 
gen that  it  contains. 

Springs  may  be  divided  into  two  classes:  Common 
springs,  yielding  fresh,  potable  water;  and  mineral 
springs,  yielding  mineral,  thermal,  or  medicinal  waters, 
in  which  the  dissolved  mineral  matters  render  them  unfit 


94  WA  TER  AND   WA  TER-SUPPL  Y. 

for  ordinary  domestic  use,  though  of  great  value  for 
therapeutic  purposes. 

Ordinary  spring-water  usually  contains  the  gases  of  the 
atmosphere  in  solution.  It  also  contains  various  mineral 
salts  in  solution,  such  as  calcium  carbonate  and  sulphate, 
magnesium  carbonate  and  chlorid,  sodium  chlorid,  alka- 
line sulphates  and  nitrates,  and  silicates.  The  amount 
of  organic*  matter  is  usually  small,  and  the  content  in 
free  and  albuminoid  ammonia  is  low.  The  temperature 
of  spring-water  is  usually  lower  than  that  of  the  surround- 
ing air. 

Well-water,  if  derived  from  a  deep  well,  is  similar  in 
character  to  spring-water;  but  if  derived  from  a  shallow 
well  it  is  contaminated  with  surface  washings.  Spring- 
water  is  usually  soft,  while  some  well-waters  are  moder- 
ately hard  because  of  the  presence  of  calcium  and  mag- 
nesium salts  in  the  rocks  of  the  locality.  Spring-  and 
well-waters  are  usually  not  rich  in  bacteria  unless 
specially  polluted. 

River-water. — The  course  of  a  great  river  may  be 
divided  into  three  portions — the  mountain  track,  the 
valley  track,  and  the  plain  track;  and  the  composition 
of  the  water  varies  considerably  in  these  three  portions 
of  its  course.  In  the  first  part  it  is  comparatively  pure 
and  partakes  of  the  nature  of  spring- water;  in  the  second 
and  third  parts  it  is  usually  more  or  less  polluted,  depend- 
ing upon  the  density  of  the  population  along  its  course. 
The  composition  of  river-water  is  complex,  as  in  the 
case  of  spring- water,  as  the  water  of  rivers  is  largely  de- 
rived from  springs.  The  proportion  of  organic  matter 
and  of  free  and  albuminoid  ammonia  is  usually  higher 
than  in  spring- water;  and  if  polluted  with  sewage  the 
proportion  of  chlorin  is  also  considerably  higher.  The 
character  of  the  water  varies  greatly  with  the  amount  of 
rainfall  and  with  the  nature  of  the  soil-covering  of  the 
valley  and  plain  tracks.  River-water  is  usually  rich 
in  bacteria,  the  number  and  variety  of  species  varying 


COMPARISON  OF  NA  TURAL   WA  TERS.  95 

greatly  with  the  season  of  the  year  and  the  amount  of 
sewage  pollution. 

I^ake-water. — Lake-water  is  of  variable  composition, 
the  water  of  salt  lakes  being  loaded  with  mineral  con- 
stituents, while  that  of  fresh  lakes  is  usually  of  great 
purity.  Fresh-water  lakes  act  as  settling  basins  for  the 
inflowing  water.  The  sudden  diminution  in  the  velocity 
of  the  current  causes  the  subsidence  of  suspended  mat- 
ters, while  oxidation  of  organic  matters  takes  place  from 
exposure  of  so  large  a  surface  to  the  atmosphere,  and 
from  the  action  of  microscopic  plants  and  bacteria. 

Sea-water. — Sea-water  is  appreciably  alkaline  from 
the  presence  of  carbonates.  The  proportion  of  solids  in 
solution  is  about  3.5  per  cent;  chlorin  being  the  chief 
constituent,  while  sodium,  calcium,  and  magnesium  are 
next  in  amounts.  It  also  contains  considerable  amounts 
of  atmospheric  gases,  even  at  great  depths,  the  average 
amount  being  from  2  to  3  per  cent,  by  volume. 

Comparison  of  Natural  Waters. — The  Rivers'  Pol- 
lution Commission  of  England,  in  their  sixth  report, 
classify  waters  as  follows: 

I.  In  respect  of  wholesomeness,  palatability,  and 
general  fitness  for  drinking  and  cooking: 

(I.  Spring- water.  1 

2.  Deep-well  water.  }  Ver?  PaIatable- 

3.  Upland  surface-water.  J  Moderately  pa]afable_ 

b.  Suspicious.      J  4-  Stored  rain-water.  J 

I-  5.  Surface-water  from  cultivated  land.  -> 

c.  Dangerous.       f  6.  River-water  to  which  sewage  gains  access.  I  Palatable. 

1  7.  Shallow-well  water.  J 

II.  In  respect  to  softness: 

1.  Rain-water. 

2.  Upland  surface-water. 

3.  Surface-water  from  cultivated  land. 

4.  Polluted  river-water. 

5.  Spring-water. 

6.  Deep-well  water. 

7.  Shallow-well  water. 


96  WA  TER  AND   WA  TER-SUPPL  Y. 

Impurities  in  Water. — By  the  term  impurities  is 
meant  such  substances  as  are  directly  injurious  to  health, 
or  that  from  their  association  are  indicative  of  pollution 
though  in  themselves  they  may  be  harmless.  The  im- 
purities in  water  may  be  either  in  suspension  or  solution, 
and  they  may  be  either  gaseous  or  solid,  organic  or  in- 
organic. 

Many  of  the  inorganic  constituents  of  water  are  inju- 
rious only  when  present  in  considerable  amounts — as, 
for  instance,  the  salts  of  calcium  and  magnesium.  These, 
when  present  in  large  amounts,  render  the  water  hard 
and  therefore  unsuited  for  domestic  use,  aside  from  the 
fact  that  they  are  productive  of  disordered  function  of 
the  gastro-intestinal  apparatus.  Under  certain  con- 
ditions the  salts  of  calcium  and  magnesium  are  also 
believed  to  produce  goiter.  The  amount  of  sodium 
chlorid  commonly  found  in  natural  waters  is  not  objec- 
tionable, because  it  is  much  smaller  than  the  amounts 
constantly  used  in  seasoning  food.  Sodium  chlorid  is, 
however,  a  most  important  indication  of  the  pollution  of 
surface-waters  by  means  of  sewage,  since  sewage  is  rich 
in  chlorin  derived  from  urine.  In  determining  the 
significance  of  the  amount  of  chlorin  found  in  any  water, 
it  is  necessary  to  know  the  normal  chlorin  content  of  the 
surface-waters  of  the  locality,  since  the  amount  of  chlorin 
normally  present  in  surface-waters  varies  greatly.  The 
amount  is  influenced  by  the  proximity  to  the  ocean  or 
other  bodies  of  saline  water,  by  the  proximity  to  natural 
deposits  of  salt,  and  by  the  geologic  formation  of  the 
locality.  The  chlorin  content  of  surface-waters  of  the 
natural  gas  and  oil  regions  is  especially  high,  and  this 
■  fact  must  be  borne  in  mind  in  determining  the  source 
of  chlorin  present  in  water  from  such  a  locality.  The 
amount  of  nitrates  and  nitrites  commonly  found  in  sur- 
face-waters is  without  influence  upon  health.  These 
substances  are,  however,  of  great  interest  and  importance 
as  indications  of  the  length  of  time  that  has  elapsed 


IMPURITIES  IN  WA  TER.  97 

since  the  water  has  been  polluted  and  the  extent  of 
the  pollution. 

The  organic  impurities  in  water  are  of  two  kinds,  dead 
organic  matter  of  vegetable  and  animal  origin,  and 
living  organisms.  The  amount  of  dead  organic  matter 
commonly  found  in  surface-waters  is  without  effect  upon 
health.  It  serves,  however,  as  a  most  important  indi- 
cator of  the  extent  and  character  of  pollution.  The 
organic  matter  present  in  water  is  usually  divided  into 
the  nitrogenous  organic  matter  and  the  oxidizable  organic 
matter.  The  nitrogenous  organic  matter  usually  repre- 
sents animal  organic  matter,  and  is  estimated  in  the 
form  of  free  and  albuminoid  ammonia,  though  it  is  not 
always  of  animal  origin,  as  certain  vegetable  compounds 
also  yield  ammonia  on  distillation,  and,  therefore,  are 
nitrogenous  in  character.  The  oxidizable  organic  matter 
is  usually  of  vegetable  origin,  and  is  determined  by  its 
bleaching  effect  upon  a  solution  of  potassium  permanga- 
nate. Neither  the  nitrogenous  organic  matter  nor  the 
oxidizable  organic  matter  is,  as  a  rule,  directly  injurious 
to  health,  and  these  also  are  of  importance  principally  as 
indicators  of  the  nature  and  extent  of  pollution. 

In  making  the  estimates  of  the  amounts  of  these 
various  organic  and  inorganic  impurities  in  water  it  is 
necessary  to  bear  in  mind  that  all  waters  contain  certain 
amounts  of  these  substances.  It  is  only  when  the  quanti- 
ties of  these  substances  found  exceed  to  an  appreciable 
extent  the  normal  content  of  the  surface-waters  of  the 
locality  that  they  become  indicators  of  pollution. 

The  living  organisms  found  in  water  may  be  either 
of  vegetable  or  animal  origin.  The  vegetable  organisms 
found  in  polluted  water  are  of  two  kinds,  the  pathogenic 
and  putrefactive  bacteria,  and  those  organisms  which  are 
of  a  somewhat  higher  organization — certain  chlorophyl- 
bearing  organisms. 

The  bacteria  found  in  polluted  water  which  are  of  the 
greatest  importance  are  the  various  pathogenic  organisms, 
the  most  important  of  which  are  the  typhoid  bacillus,  the 
7 


98  WATER  AND   WATER-SUPPLY. 

cholera  organism,  and  the  Bacillus  enteritidis  sporogenes 
of  Klein.  The  Bacillus  coli  communis  is  also  of  impor- 
tance, because  it  is  normally  present  in  the  intestinal  dis- 
charges of  man  and  the  domestic  animals.  But  its  dis- 
covery  in  any  surface-water  is  not  positive  indication  of 
sewage  pollution,  as  it  may  have  gained  entrance  froni 
street-washings  or  from  the  fecal  matter  of  any  of  the 
domestic  animals.  Its  presence  in  a  water  is  cause,  how-' 
ever,  for  suspicion,  because  it  shows  that  the  water  is  not 
properly  protected  against  pollution. 

The  presence  of  the  Bacillus  enteritidis  sporogenes 
is  believed  by  Klein  to  indicate  sewage  pollution  to  an 
equal  extent  with  the  presence  of  the  colon  bacillus.  It 
is  regarded  as  a  frequent  factor  in  the  production  of  diar- 
rheal diseases,  especially  in  infants.  There  are  also  a 
number  of  common  putrefactive  bacteria  which  are  not 
normally  present  in  pure  surface-waters,  and  the  presence 
of  which  is,  to  some  extent  at  least,  indicative  of  pollu- 
tion. This  is  believed  to  be  true  of  such  organisms  as 
those  of  the  proteus  group  and  the  lactic-acid  group,  and 
these  organisms  may  be  instrumental  in  producing  gas- 
trointestinal disturbances  when  present  in  water  in  large 
numbers.  The  various  pyogenic  cocci  may  also  occa- 
sionally be  found  in  polluted  waters,  and  their  presence 
in  such  waters  is  always  objectionable. 

Bacteria  are  present  to  a  greater  or  less  extent  in  all 
natural  waters.  Many  species  have  their  normal  habitat 
in  water  and  in  the  soil,  through  which  they  gain  en- 
trance to  surface-waters.  The  point  of  hygienic  impor- 
tance is,  therefore,  not  whether  bacteria  are  present  or 
absent,  because  they  are  practically  never  absent;  not 
whether  they  are  few  or  many  in  number,  because  no 
direct  relation  has  been  proved  to  exist  between  their 
number  and  the  purity  or  impurity  of  the  water,  though, 
as  a  rule,  the  larger  the  number  present  the  greater  the 
amount  of  food-supply  for  bacteria  in  such  water,  and 
hence  the  better  facility  for  growth  and  development  of 
all  species;    nor   even    how   many  different  species  are 


IMPURITIES  IN  WA  TER.  99 

present.  The  point  of  real  hygienic  importance  is  to 
determine  whether  the  water  does  or  does  not  contain 
any  of  the  organisms  of  specific  diseases.  Since  the 
detection  of  the  typhoid  bacillus  in  suspected  waters,  by 
the  methods  known  at  the  present  time,  is  practically 
impossible  the  bacteriologist  is  compelled  to  base  his 
opinion  as  to  the  purity  of  a  water  upon  the  associated 
species  present,  as  well  as  upon  the  relative  number  of 
bacteria  in  the  water.  This  is  the  only  safe  criterion  at 
the  present  time.  It  is  inferred  that  a  water  rich,  in  bac- 
teria contains  the  necessary  food-supply  for  the  growth 
and  development  of  bacteria,  and  hence  it  would  support 
the  life  of  any  pathogenic  species  that  might  gain  access 
thereto. 

The  chlorophyl-bearing  organisms  found  in  surface- 
waters  are,  as  a  rule,  harmless,  but  certain  species  when 
present  in  reservoir-water  give  rise  to  disagreeable  odors 
and  taste,  and  hence  are  objectionable.  These  odors  are 
usually  produced  by  the  growth  of  algae,  or  diatoms. 
The  principal  algae  which  have  been  found  to  produce 
these  disagreeable  odors  in  stored  water  are  different 
varieties  of  volvox,  uroglena,  and  anabena.  The  diatom 
asterionella  has  been  found  to  cause  a  "  geranium  "  odor 
and  taste  in  stored  water.  Another  pest  of  water-works 
which  has  caused  a  great  deal  of  trouble  in  filling  up  the 
pipes  and  causing  a  brown  sediment  in  the  water  is  the 
so-called  "iron  bacterium,"  or  crenothrix.  It  has  the 
power  of  secreting  iron  in  its  sheath.  Although  it  is  a 
decided  nuisance,  it  is  not  known  to  have  anv  harmful 
effect  on  health. 

These  organisms,  producing  the  disagreeable  odors  in 
stored  water,  are  unable  to  grow  in  the  absence  of  sun- 
light, and  the  most  satisfactory  means  of  inhibiting  their 
growth  in  stored  waters  is  to  cover  the  reservoirs,  so  as 
to  exclude  light. 

The  more  important  animal  organisms  in  polluted 
waters  are  the  eggs  and  larvae  of  certain  animal  para- 
sites, as  the  eggs  of  the  round  worm,  due  to  pollution 


IOO  WA  TER  AND   WA  TER-SUPPL  Y. 

with  hog  excrement;  the  eggs  of  Ankylostoma  duodenale 
and  Rhabdonema  intestinale,  and  the  Guinea-worm,  all 
of  which  are  due  to  the  pollution  of  water  through  fecal 
matter.  Amebic  dysentery  is  another  disease  which  is 
believed  to  be  carried  in  polluted  water. 

The  gaseous  impurities  in  water  are  few  in  number 
and  of  somewhat  doubtful  importance.  They  are  hydro- 
gen sulphid,  sulphur  dioxid,  and  the  gaseous  emanations 
arising  from  putrefaction,  as  ammonia,  carbon  dioxid, 
and  marsh  gas.  These  gases  are  usually  found  in  water 
that  is  charged  with  the  gaseous  emanations  from  sewers. 

The  solid  impurities  are  principally  mineral  particles, 
such  as  sand,  clay,  and  fine  particles  of  mica.  These 
arise  from  the  soil  over  or  through  which  the  water 
passes,  and  are  most  plentiful  at  the  time  of  freshets. 

Effects  of  Impurities  in  Water. — Gaseous  Impuri= 
ties —  Hydrogen  sulphid  and  the  gaseous  emanations 
from  sewers  appear  to  produce  diarrhea.  Sulphur  dioxid, 
when  present  in  considerable  quantities,  produces  disease 
of  the  bones  in  cattle. 

Mineral  Particles — Any  water  that  is  markedly  turbid, 
even  though  the  suspended  matter  be  without  disease- 
producing  qualities  in  itself,  may  cause  diarrhea.  This 
is  the  case  with  the  muddy  waters  of  the  Ganges,  the 
Mississippi,  and  other  rivers,  especially  at  certain  seasons 
of  the  year;  the  turbidity  being  due  to  clayey  particles 
along  with  vegetable  matter.  Finely  divided  mica 
scales  are  said  to  cause  the  "hill  diarrheas"  of  certain 
districts  of  India.  Suspended  animal  matters  (especially 
fecal)  cause  diarrhea  and  dysentery,  and  there  is  little 
doubt  that  such  water  predisposes  to  typhoid  fever  or 
cholera  in  some  degree,  by  causing  an  irritable  condition 
of  the  alimentary  tract. 

Dissolved  Solid  Impurities. — Inorganic  Impurities. 
— The  inorganic  impurities  dissolved  in  water  may  be 
divided  into  three  classes  :  The  actively  poisonous  min- 
erals sometimes  found  in  water,  as  lead,  zinc,  and  arsenic; 
the  alkaline  and  earthy  salts,  and  iron,  derived  from  the 


DISSOLVED  SOLID  IMPURITIES.  101 

soil;  and  those  salts  which,  though  not  in  themselves 
injurious  to  health,  are  indicative  of  the  nature  and 
extent  of  the  pollution  of  the  water.. 

The  contamination  of  drinking-water  by  the  poisonous 
metals  is  rare  except  in  the  case  of  lead.  The  solvent 
action  of  water  on  lead  pipes  is  dependent  upon  a  variety 
of  conditions.  The  temperature  of  the  water  is  an 
important  factor.  Hot  water  dissolves  lead  much  more 
readily  than  cold  water.  The  character  of  the  water  is 
also  an  important  factor.  Soft  waters,  as  a  rule,  are 
better  solvents  than  hard  waters.  The  presence  of  con- 
siderable amounts  of  dissolved  oxygen  in  water  some- 
times acts  as  a  solvent.  Certain  organic  acids  in  water 
are  also  believed  to  act  as  solvents.  Certain  forms  of 
micro-organisms  seem  to  favor  the  solvent  action.  The 
amount  of  lead  which  will  produce  symptoms  of  poison- 
ing is  variously  stated  by  different  authors,  ranging  from 
i  part  in  700,000  to  1  part  in  7,000,000  parts  of  water; 
though  it  is  probable  that  any  quantity  over  o.  7  part  per 
1,000,000  should  be  considered  as  dangerous.  A  number 
of  propositions  have  been  made  to  prevent  the  solvent 
action  of  water  on  lead  pipe,  such  as  coating  the  interior 
of  the  pipes  with  tin,  fusible  metal,  or  with  coal-tar 
varnish.  The  safest  method  of  preventing  lead-poison- 
ing is  the  substitution  of  iron  pipes  for  lead  pipes  where- 
ever  possible.  Since  the  solvent  action  is  a  rather  slow 
process,  there  is  very  little  danger  from  the  plumbing  of 
modern  dwellings  unless  water  is  used  which  has  been 
standing  in  the  pipes  for  some  time.  The  first  portion 
of  the  water  drawn  in  the  morning  should  always  be 
discarded  for  this  reason,  as  it  is  the  portion  most  likely 
to  contain  lead. 

The  alkaline  earthy  salts  in  water,  constituting  what 
is  known  as  the  hardness  of  water,  are  believed  to  exer- 
cise some  effect  on  those  constantly  using  hard  waters. 
Such  waters  are  believed  to  be  productive  of  calculus 
and  goiter.  It  is  not  easy  to  differentiate  the  effects  of 
the  several  earthy  salts,  though  the  calcium  salts  appear 


102  WA  TER  AND   WA  TER-SUPPL  Y. 

to  produce  diarrhea,  while  the  magnesium  salts  appear 
to  be  concerned  in  the  production  of  goiter.  Iron  causes 
dyspepsia  and  constipation,  and  the  sulphid  is  believed 
to  be  productive  of  goiter. 

Organic  Impurities. — Dissolved  vegetable  matters,  if 
derived  from  marshes,  are  considered  harmful,  and  are 
believed  to  be  concerned  in  the  production  of  fevers. 
Any  dissolved  organic  matter,  whether  vegetable  or 
animal,  if  present  in  large  amount,  may  produce  diarrhea. 
The  animal  matter  derived  from  graveyards  appears  to 
be  especially  injurious.  It  must  be  borne  in  mind,  how- 
ever, that  the  effects  here  attributed  to, the  organic  im- 
purities in  water,  in  the  light  of  our  present  knowledge, 
must  be  attributed  largely  to  the  influence  of  micro- 
organisms simultaneously  present. 

Bacteria. — The  diseases  produced  by  the  presence  of 
specific  pathogenic  bacteria  in  drinking-water  are  typhoid 
fever,  Asiatic  cholera,  and  diarrhea,  through  the  presence 
of  the  Bacillus  enteritidis  sporogenes.  In  addition  to 
these  diseases,  diarrhea  and  dysentery  may  be  produced 
through  the  presence  of  certain  other  micro-organisms 
in  drinking-water. 

Typhoid  Fever. — The  belief  that  typhoid  fever  can  be 
communicated  through  drinking-water  is  comparatively 
modern.  Austin  Flint,  in  this  country,  and  Alfred  Car- 
penter, in  England,  about  1852,  having  been  the  first  to 
establish  the  fact.  It  is  now  hardly  questioned  by  any 
one  that  has  studied  the  history  of  different  epidemics. 
Hirsch  considers  that  few  points  in  the  etiology  of 
typhoid  fever  are  so  certainly  proved  as  the  conveyance 
of  the  specific  bacilli  by  drinking-water,  or  by  food  con- 
taminated with  polluted  drinking-water.  The  Bacillus 
typhi  abdominalis  is  the  actual  cause  of  the  disease,  and 
no  water  can  convey  the  disease  without  containing  the 
specific  organism. 

A  number  of  epidemics  of  typhoid  fever  have  been 
traced  directly  to  polluted  drinking-water.  The  preva- 
lence of  typhoid  fever  in  any  community  should  always 


DISSOL  VED  SOLID  IMPURITIES.  103 

lead  to  an  investigation  of  the  nature  of  the  water-supply 
and  the  removal  of  sources  of  pollution.  Cities  using 
polluted  river-  or  lake-water  always  have  a  high  death- 
rate  from  typhoid  fever.  Changing  to  a  pure  water- 
supply  or  the  purification  of  the  polluted  wTater  is  followed 
immediately  by  a  reduction  in  the  mortality  from  typhoid 
fever.  The  reduction  in  the  death-rate  from  typhoid 
fever  at  Lawrence,  Mass.,  after  the  construction  of  a 
sand  filter,  wTas  most  marked,  and  has  continued  low 
ever  since.  The  reduction  in  the  death-rate  from  typhoid 
fever  in  Newark  and  Jersey  City,  X.  J.,  after  abandoning 
the  polluted  water  of  the  Passaic  River  for  impounded 
surface-water,  was  also  quite  marked,  though  far  less  so 
than  at  Lawrence,    Mass. 

Asiatic  Cholera. — The  question  of  the  spread  of  cholera 
by  water  is,  in  many  respects,  as  well  established  as  the 
spread  of  typhoid  fever.  The  theory  of  the  spread  of 
cholera  through  drinking-water  dates  back  to  the  writings 
of  Dr.  Snow  in  1849  anc^  T^54-  '^ne  specific  organism 
of  cholera  is  the  "comma  bacillus,"  or  spirillum  dis- 
covered by  Koch  in  1882. 

The  relation  of  polluted  water-supplies  to  outbreaks 
of  cholera  is  shown  most  graphically  in  the  accompanying 
chart  (Fig.  22)  indicating  the  experiences  of  the  adjoin- 
ing cities  Hamburg  and  Altona,  in  1892.  Both  cities 
derived  their  water-supply  from  the  river  Elbe.  Ham- 
burg used  the  raw,  unfiltered  water.  The  supply  of 
Altona  was  taken  from  the  river  at  a  point  below  the 
Hamburg  sewer  outfall,  but  subjected  to  sand  filtration. 
The  two  cities  adjoin,  and  are  practically  one  city;  the 
division  between  the  two  for  the  most  part  follows  one 
of  the  streets.  There  were  16,957  cases  and  8606  deaths 
from  cholera  in  Hamburg,  and  only  516  cases  and  316 
deaths  in  Altona  during  the  same  time,  giving  a  death- 
rate  of  1343  per  100,000  of  population  for  unfiltered 
river- water,  and  a  death-rate  of  211  per  100,000  of  popu- 
lation for  filtered  water.  A  number  of  the  cases  occur- 
ring  in   Altona   were    traced    directly    to    infection    by 


104 


WA  TER  AND   WA  TER-SUPPL  Y. 


Hamburg  water  occurring  in  persons  working  in  Ham- 
burg but  living  in  Altona. 

Diarrhea  and  Dysentery. — Klein1  believes  the  Bacil- 


CHOLERA 


Fig.  22. — The  black  dots  show  the  location  and  number  of  the  cholera  cases 
in  both  Hamburg  (to  the  right  of  the  red  dividing  line)  and  Altona  (to  the 
left  of  that  line)  (Abbott). 

lus  enteritidis  sporogenes  to  be  the  etiologic  factor  in 
many    cases    of    diarrhea,    and    that    it    probably   gains 

1  Report  of  the  Medical  Officer  of  the  Local  Government  Board  for  1895-96 
and  1897-98. 


COMPOSITION  OF  DRINKING-WATER.  105 

entrance  to  drinking-water  through  sewage  and  surface- 
washings  containing  the  fecal  matter  of  domestic  ani- 
mals. The  Bacillus  dvsenteriae  described  bv  Shiea, 
Flexner,  and  others,  is  now  generally  regarded  as  the 
cause  of  acute  dysentery,  and  this  organism  is  also 
carried  in  infected  waters.  Besides  these,  certain  putre- 
factive organisms,  such  as  those  of  the  proteus  and  lac- 
tic-acid groups,  are  also  believed  to  be  concerned  in  the 
causation  of  diarrhea  and  dysentery  under  certain  con- 
ditions. 

Goiter. — It  has  always  been  a  widespread  belief  that 
goiter  and  cretinism  are  caused  by  the  use  of  drinking- 
water  from  particular  sources,  and  there  is  some  founda- 
tion for  this  belief.  These  diseases  appear  to  be  asso- 
ciated, to  some  extent  at  least,  with  certain  geologic  for- 
mations, especially  those  localities  in  which  magnesian 
limestone  is  found.  Various  observers  have,  in  turn, 
considered  the  salts  of  calcium  and  magnesium,  as  well 
as  other  metallic  substances,  especially  iron  sulphate,  or 
copper,  or  deficiency  of  chlorids  or  of  iodin,  to  be  the 
cause.  Hirsch  believes  that  endemic  goiter  should  be 
considered  as  an  infectious  disease  produced  by  a  specific 
poison. 

Cancer. — Within  recent  years  the  discovery  of  organ- 
isms in  cancerous  tumors  has  given  rise  to  the  belief  that 
this  disease  is  produced  by  an  organism  derived  from  the 
soil  or  water.  Thus  far  the  evidence  brought  forward  to 
substantiate  this  belief  has  not  been  sufficient  to  settle 
the  question  definitely. 

Approximate  Composition  of  Drinking-water. — 
De  Chaumont  classified  different  waters  into  four  classes, 
with  regard  to  their  degree  of  purity.  This  classifica- 
tion is  serviceable  in  forming  an  opinion  as  to  the  use- 
fulness of  a  water  for  domestic  purposes,  though  it  can- 
not be  followed  strictly  in  every  particular,  because  geo- 
logic conditions  may  influence  the  constitution  of  a  water 
to  such  an  extent  as  to  bring  it  under  the  class  of  sus- 
picious or  impure  waters  with  regard  to  the  mineral  con- 


io6 


WA  TER  AND   WA  TER-SUPPL  Y. 


stituents,  without  really  rendering  the  water  suspicious. 
It  is  always  necessary  to  have  some  knowledge  of  the 
geologic  formation  of  the  locality. 


Chemical  constituents  stated  in 
parts  per  i, 000,000. 

Total  solids 

Chlorin 

N  as  nitrates 

N  as  nitrites 

N  as  free  NH3 

N  as  albuminoid  NH3  .    .    . 
Organic  matter 


Pure. 

Usable. 

Less  than 

Less  than 

70.000 

43O.O0O  ; 

I4.000 

4O.OOO 

O.I4O 

1. 1 20 

nil 

nil 

0.020 

0.050 

0.050 

O.IOO 

0.250 

1. 000 

Suspicious. 


24.OOO 


450.000  to  7 IO. COO 

40  coo  to    70.000 

1. 1 20  to 

O.50O 

0.050  to 
O.IOO  to 
1. 000  to 


O.IOO 

0.125 

1.500 


Impure. 


Over 
7IO.OOO 
70.OOO 
2.4OO 
O.500 
O.IOO 

0.125 

1.500 


Amount  of  Drinking-water  Required  Daily.— For 
Drinking  and  Cooking. — An  adult  requires,  on  an  average, 
3  liters  of  water  daily;  of  this  amount,  i  liter  is  con- 
tained in  the  solid  food  that  is  ingested.  About  2  liters 
should  be  allowed  for  drinking-purposes,  either  as  plain 
water,  or  as  tea,  coffee,  etc. 

For  Ablution. — The  quantity  used  varies  very  much 
according  to  the  cleanliness  of  the  individual.  About  25 
liters  may  be  allowed,  of  which  10  to  15  liters  will  serve 
for  a  sponge  bath.  If  a  general  bath  is  taken,  the  daily 
amount  is  very  much  increased,  and  may  be  stated  at 
from  250  to  300  liters. 

For  Laundry  and  Kitchen  Use. — About  15  liters  may 
serve  for  laundry  purposes,  and  the  same  amount  for 
house  and  utensil  cleansing. 

For  Water=cIosets. — The  usual  quantity  provided  in 
the  "water-waste-preventer"  cisterns  now  supplied  to 
closets  is  10  to  15  liters.  These  contrivances  effect  a 
great  saving  in  water  and  meet  all  the  requirements. 

For  other  Purposes. — The  need  of  water  in  cities  for 
other  than  domestic  purposes,  such  as  manufacturing, 
washing  of  sidewalks,  sprinkling  of  streets  and  lawns,  and 
for  hospitals,  brings  the  daily  supply  up  to  a  very  large 
amount.  The  estimations  of  the  Chief  of  the  Bureau  of 
Water  of  Philadelphia,  of  750  liters  per  head  per  day, 
should  meet  all  legitimate  requirements.     The  supply  of 


SOURCE  OF  WATER-SUPPLIES.  107 

890  liters  per  day  shows  that  there  is  an  enormous  waste 
of  water.1 

Source  of  Water-supplies. — Surface=water — By  sur- 
face-water is  meant  the  water  discharged  from  the  sur- 
face of  a  catchment  area,  as  opposed  to  that  collected 
from  wells  and  galleries.  Strictly  speaking,  the  water 
in  rivers  and  lakes  is  surface-water;  but  as  the  supply 
from  these  sources  is  often  obtained  by  special  works  it 
is  convenient  to  restrict  the  term  surface-water  to  sup- 
plies obtained  by  means  of  impounding  reservoirs.  Such 
surface  supplies  depend  upon  the  rainfall  for  their  ex- 
istence and  upon  the  natural  features  of  the  watershed 
for  their  character. 

It  is  generally  possible  to  secure  statistics  of  the  rain- 
fall in  the  neighborhood  of  most  places  large  enough  to 
have  water-works,  and  from  such  statistics  and  an  in- 
spection of  the  catchment  area  the  probable  amount  of 
water  usually  available  may  be  determined.  The  maps 
of  the  State  and  National  geologic  surveys  are  of  much 
value  in  determining  the  sources  from  which  a  supply 
may  be  obtained. 

The  surface  area  that  is  necessary  in  order  to  furnish 
a  supply  sufficient  for  a  large  city  is  enormous.  The 
water-supply  of  a  large  part  of  New  York  City  is  derived 
from  the  Croton  watershed,  and  it  is  frequently  stated 
that  the  amount  of  water  available  is  barely  sufficient  for 
present  purposes,  and  that  preparation  must  be  made  for 
an  extension  without  delay.  In  a  recent  report  to  the 
mayor  of  the  city  the  water-supply  commissioner  as- 
serts: "The  people  and  government  of  the  city  must 
now  and  without  delay  face  the  choice  between  two 
alternatives:  They  must  either  take  prompt  and  decisive 
action  for  the  acquisition  of  large  additions  to  the  water- 
supply  beyond  the  Croton  watersheds,  or  institute  meas- 
ures to  reduce  the  per  capita  consumption  of  water.  The 
average  daily  consumption  of  Croton  water  has  increased 

1  See  "  Report  of  the  Mayor  of  Philadelphia  on  Extension  and  Improve- 
ment of  the  Water-supply,"  1899. 


108  WA  TER  AND   WA  TER-SUPPL  Y, 

from  223,000,000  gallons  in  1898  to  253,000,000  gallons 
in  1899.  At  the  same  annual  increase  in  succeeding 
years  the  limit  of  the  capacity  of  the  two  Croton  aque- 
ducts— 380,000,000  gallons  a  day — will  be  reached  and 
exceeded  in  five  years,  a  shorter  time  than  that  in  which 
it  would  be  possible  to  acquire  new  sources  of  supply 
and  to  build  new  reservoirs  and  new  aqueducts." 

The  quality  of  the  water  from  a  watershed  depends 
upon  the  population  of  the  area,  the  number  of  swamps 
in  it,  and  the  nature  of  the  geologic  strata  over  which  it 
flows.  If  the  population  on  the  watershed  exceeds  about 
100  per  square  kilometer,  the  stored  water  is  in  danger 
of  being  polluted,  and  often  proves  troublesome  from  bad 
taste  and  odor.  If  there  are  numerous  swamps  on  the 
watershed,  the  water  is  likely  to  be  dark  in  color,  and 
may  be  objectionable  on  this  account.  If  limestone  is 
common,  the  water  is  liable  to  be  too  hard  for  either 
domestic  use  or  for  manufacturing  purposes. 

The  suitability  of  the  water  for  a  municipal  supply 
depends  upon  its  freedom  from  sewage  contamination, 
the  degree  of  hardness,  as  well  as  its  color,  odor,  and 
taste.  Its  general  character  may  be  determined  by  an 
inspection  of  the  entire  watershed. 

Supplies  from  Rivers. — The  nature  and  amount  of 
water  available  from  a  river  must  be  determined  by 
systematic  study  of  the  flow  at  both  high-  and  low- 
water  seasons.  The  character  of  the  river-water  will 
depend  upon  the  density  of  the  population  along  its 
entire  length,  the  nature  of  the  surface-covering  of  the 
watershed,  and  the  nature  of  the  geologic  formations. 

In  comparing  the  relative  advantages  of  river-water 
and  of  impounded  surface-water,  it  is  necessary  to  take 
into  account  the  amount  of  water  obtainable  from  either 
source,  the  relative  purity  of  each,  and  the  expense  of 
extending  both  systems  so  as  to  meet  the  demands  of 
the  future.  This  question  has  been  under  discussion 
in  Philadelphia  for  a  long  time,  owing  to  the  degree 
of  pollution   of  the   present  supply.      Many  competent 


SOURCE  OF  WATER-SUPPLIES.  109 

observers  had  made  more  or  less  exhaustive  studies  of 
the  conditions  involved,  but  with  varying  results;  some 
favoring  the  abandonment  of  the  present  supply  and 
resorting  to  the  use  of  impounded  water  from  the  head- 
waters of  the  tributaries  of  the  Delaware  and  Schuylkill 
Rivers,  others  favoring  the  purification  of  the  present 
supply  as  being  the  most  feasible  and  the  less  expensive 
procedure.  The  commission  of  experts  appointed  early 
in  1899  to  make  another  detailed  study  of  the  whole 
question  reported  in  favor  of  filtration  of  the  present 
supply.     This  plan  is  the  one  which  it  is  now  proposed 

to  adopt. 

Lake  and  Pond  Supplies. — The  use  of  lakes  and  ponds 
as  sources  of  supplies  is  not  available  for  many  localities. 
Where  such  supplies  are  available  and  they  are  of 
undoubted  purity,  they  usually  meet  all  the  conditions. 
In  the  use  of  lake-waters  the  disposal  of  sewage,  how- 
ever, becomes  a  serious  problem,  as  in  Chicago.  Here 
the  sewage  was  disposed  of  by  leading  it  back  into  the 
lake,  with  the  result  of  polluting  the  lake-water  to  such 
an  extent  as  to  render  it  dangerous.  Even  carrying  the 
intake  far  out  into  the  lake  failed  to  remedy  the  matter 
satisfactorily,  and,  as  a  result,  the  drainage  canal  leading 
to  the  Mississippi  River  was  constructed  to  dispose  of  the 
sewage. 

Ground=water  Supplies. — There  are  two  classes  of 
ground-water,  the  water  which  filters  from  a  river  or 
pond  into  the  soil  forming  its  basin,  and  the  water  which 
has  entered  the  ground  from  a  variety  of  sources,  but  has 
been  checked  in  its  downward  percolation  by  more  or 
less  impervious  strata. 

The  water  of  the  first  class  retains  many  of  the  char- 
acteristics of  the  river-  or  pond-water  from  which  it  is 
derived,  though  the  nature  of  the  soil  through  which  it 
passes  influences  its  character  to  some  extent,  improving 
it  during  its  passage  through  the  soil.  The  water  of  the 
second  class  is  influenced  to  some  extent  by  the  geologic 
formation  of  the  locality  and  the  depth  to  which  it  has 


1 10  WA  TER  AND   WA  TER-SUPPL  Y. 

penetrated.  Generally  it  is  a  water  of  considerable 
purity,  resembling  the  water  of  natural  springs  in  its 
general  composition. 

With  regard  to  the  method  of  collecting  ground-water, 
the  general  plans  must  vary  with  the  particular  conditions 
presented  by  the  locality.  These  methods,  in  a  general 
way,  may  be  said  to  be  either  by  means  of  a  large  circu- 
lar well,  of  tubular  wells,  or  of  filtering  galleries. 

The  amount  of  water  that  may  be  obtained  from  deep 
and  shallow  wells  depends  upon  the  same  conditions  as 
those  influencing  the  amount  of  surface-water.  Besides 
this,  the  quantity  is  also  dependent  upon  the  porosity  of 
the  soil  or  its  capacity  for  storing  water.  No  more  water 
can  be  obtained  from  an  area  drained  by  the  well  than 
that  which  falls  upon  the  surface  in  the  form  of  rain. 
The  amount  of  ground-water  is  therefore  somewhat  lim- 
ited. The  largest  yields  of  ground-water  for  the  supply 
of  cities  in  this  country  have  been  as  follows: 

Brooklyn,  N.  Y., 150,000  cubic  meters  per  day. 

Memphis,  Term., 75,000  "  " 

Lowell,  Mass .     56,250  "  " 

Dayton,  Ohio, 31,650  "  " 

The  amount  of  water  that  could  be  obtained  from  this 
source  would  be  only  a  small  fractional  part  of  the  daily 
consumption  of  a  large  city.  For  small  towns  this  source 
of  supply  is  available  when  there  is  no  other  that  is 
equally  pure  and  more  accessible. 

Springs. — The  relative  purity  of  spring-waters  renders 
these  a  useful  source  of  supply.  For  small  communities 
the  supply  is  often  sufficient  for  ordinary  requirements, 
or  it  may  be  extended  by  combining  the  supply  of 
neighboring  springs.  The  nature  of  the  location  of 
many  springs  renders  them  but  little  liable  to  pollu- 
tion, and  at  the  same  time  it  frequently  renders  the 
collection  and  utilization  of  the  water  an  easy  matter. 

Artesian  Wells.— In  many  localities  the  only  available 
source  of  supply  is  that  of  artesian  wells.     The  depth 


PURIFICA  TION  OF  WA  TER.  Ill 

of  the  wells  is  dependent  upon  the  depth  at  which  water- 
bearing strata  are  to  be  found.  The  nature  of  the  water 
obtained  is  influenced  directly  by  the  chemical  composi- 
tion of  the  strata  through  which  the  water  has  passed. 
As  a  rule  these  waters  are  quite  hard,  though  of  great 
purity.  In  certain  localities,  as  in  North  and  South 
Dakota,  the  waters  are  quite  alkaline  and  contain  mineral 
matter  to  the  extent  of  4000  to  5000  parts  per  1,000,000 
parts  of  water,  or  even  more.  The  healthfulness  of 
these  waters  is  directly  dependent  upon  the  nature  and 
amount  of  mineral  matter  contained  in  them.  It  is 
evident  that  the  constant  use  of  such  waters  as  those 
found  in  the  Dakotas  would  prove  of  considerable  injury 
to  the  organs  of  elimination,  especially  the  kidneys. 
Experience  has  shown  that  these  waters  cannot  be  used 
constantly  with  impunity.  They  are  usually  used  only 
when  other  available  supplies  fail  from  long-continued 
drought. 

Storage  of  Water. — Water  is  stored  on  a  large  scale 
in  reservoirs,  and  on  a  small  scale  in  tanks  or  cisterns. 
Reservoirs  are  natural  or  artificial  basins  appropriated  or 
formed  for  the  purpose  of  reserving  or  storing  water. 
They  are  called  storage  reservoirs  when  they  are  intended 
to  retain  the  excess  of  rainfall  during  the  rainy  season  ; 
service  reservoirs  when  they  are  intended  to  hold  the 
supply  for  immediate  distribution.  Cisterns  are  neces- 
sary in  houses  supplied  on  the  intermittent  system,  as  in 
rural  districts.  The  size  of  the  cistern  will  depend  upon 
several  conditions,  as  the  amount  of  supply  required 
according  to  the  number  of  persons  occupying  the  house, 
and  the  frequency  with  which  the  supply  can  be  replen- 
ished. The  materials  used  in  the  construction  of  cis- 
terns are  usually  cement  and  slate.  These  materials 
yield  nothing  to  the  stored  water.  Common  mortar 
should  not  be  used,  because  it  gives  up  lime  to  the  water. 
Neither  should  any  metal  be  employed. 

Purification  of  Water. — The  purification  of  water 
used  for  drinking-purposes  may  be  directed  to  its  physical, 


112  WA  TER  AND    WA  TER-SUPPL  Y. 

chemical,  or  biologic  condition.  Water  that  is  turbid 
may  be  rendered  clear;  water  that  has  a  large  amount  of 
dissolved  mineral  impurities  may  be  deprived  of  them, 
at  least  to  some  extent;  water  that  contains  micro-organ- 
isms, pathogenic  or  harmless,  may  be  rendered  almost  or 
quite  free  from  bacteria.  Physical,  chemical,  and 
mechanical  means  are  employed  to  accomplish  these  ends. 

In  former  times  mechanical  purification  alone  was 
attempted,  and  a  water  that  was  clear  and  sparkling  was 
considered  fit  .to  drink,  no  regard  being  had  to  its  chemi- 
cal and  biologic  impurities.  With  the  advance  in  chem- 
ical science  and  application  of  the  knowledge  it  afforded, 
the  chief  attention  was  directed  to  the  mineral  matters  in 
solution,  especially  those  indicating  fecal  pollution. 
WTithin  recent  years,  since  the  cause  and  the  mode  of 
dissemination  of  certain  epidemic  diseases  have  been 
traced  to  the  sewage  pollution  of  drinking-waters,  the 
position  is  now  assumed  that  purification  of  water,  to  be 
efficacious,  must  not  only  render  a  water  clear  and  free 
from  mechanical  and  mineral  impurities,  but  must  also 
deprive  it  of  the  pathogenic  bacteria  contained  therein. 
This  latter  function  is  now  considered  the  most  important 
in  any  process  of  purification. 

Methods  of  Purification. — Self=purification  of  Bodies 
of  Water. — The  power  of  self-purification  which  many 
streams  and  lakes  exhibit  is  in  some  instances  quite 
remarkable.  It  was  supposed,  not  long  since,  that  pol- 
luted rivers  would,  in  time,  completely  purify  themselves. 
This  has,  however,  been  refuted  by  recent  investiga- 
tions. The  process  of  self-purification  in  streams  and 
lakes  is  a  composite  one.  The  factors  which  are  con- 
cerned in  this  process  are  the  following  : 

i.  Sedimentation.  The  suspended  particles,  both  or- 
ganic and  inorganic,  sink  to  the  bottom,  and  thus  become 
eliminated  from  the  water. 

2.  Oxidation.  In  consequence  of  the  movement  of 
the  current  the  water  becomes  aerified,  and  comes  in  con- 
tact with  fresh  portions  of  oxygen,  and  this  oxidizes  the 


ME  THODS  OF  PUR  I  FTC  A  TION.  1 1 3 

organic  matter.     Sunlight  accelerates  the  oxidation  of 
the  organic  matter  and  kills  off  some  of  the  bacteria. 

3.  Precipitation.  During  the  course  of  the  stream  cer- 
tain insoluble  inorganic  compounds  (as  sulphur  com- 
pounds) may  be  formed  and  precipitated,  or  humus  sub- 
stances may  be  precipitated  through  the  action  of  clay, 
aluminum  sulphate  and  hydroxid. 

4.  Dilution.  The  entrance  of  pure  water  from  the 
tributaries  and  from  ground-water  dilutes  the  water,  and 
thus  reduces  the  degree  of  pollution. 

5.  Water  plants  of  different  forms  (as  algae)  and  infu- 
soria digest  dissolved  and,  at  times,  undissolved  organic 
substances,  and  therefore  purify  the  water  from  these 
substances. 

6.  The  micro-organisms  convert  the  organic  matter 
into  simple  inorganic  compounds,  such  as  carbon  dioxid, 
ammonia,  and  water,  and  purify  the  water  in  this  manner. 

In  a  paper  on  the  oxidation  processes  in  river-water, 
Dr.  Oskar  Spitta  x  states  that  self-purification  of  a  stream 
is  not  confined  to  the  removal  of  suspended  particles,  but 
that  the  process  of  purification  also  removes  dissolved 
substances  coming  from  sewers.  The  latter  purification 
process  consists  primarily  of  the  solution  of  the  organic 
matter,  and  he  states  that  there  is  no  doubt  that  oxida- 
tion alone  can  lead  to  a  radical  removal  of  the  organic 
matter,  and  not  putrefaction,  which  results  only  in  the 
formation  of  intermediary  products. 

Spitta  sought  to  determine  whether  there  is  a  reduction 
of  organic  substance  in  the  course  of  the  stream  (Spree), 
and  whether  micro-organisms  were  concerned  in  this 
reduction.  If  there  is  a  reduction  in  organic  substances, 
he  believed  this  would  be  shown  in  the  consumption  of 
dissolved  oxygen  in  the  water  at  different  points  along 
the  course  of  the  river.  Because  of  the  fact  that  the 
reaction  with  permanganate  differs  greatly  with  different 
bodies  he  selected  the  method  of  direct  estimation  of  the 
amount  of  dissolved  dxygen   in   the  water   devised   by 

1  Arch.f.  Hygiene,  Bd.  xxxviii.,  S.  215. 


114  WATER  AND   WATER-SUPPLY. 

Winkler  and  modified  by  Chlopin.  He  recognizes  the 
fact  that  to-day  the  estimation  of  the  amount  of  dissolved 
oxygen  in  water  is  not  of  great  hygienic  significance. 

At  no  season  of  the  year,  and  at  no  part  of  the  river 
Spree,  was  a  sample  of  water  collected  which  was  free 
from  dissolved  oxygen.  Spitta  reaches  the  conclusion  that 
the  rate  of  utilization  of  the  dissolved  oxygen  in  water 
is  an  index  of  the  quantity  of  oxidizable  organic  matter 
in  the  water,  but  that  the  amount  of  oxygen  consumed 
per  hour  in  the  water  differs  with  the  kind  of  bacteria 
present.  He  concludes  that  light  exerts  a  favorable 
influence  upon  the  action  of  algae  and  diatoms,  and  an 
unfavorable  influence  upon  the  action  of  bacteria. 

Jordan  1  studied  the  extent  of  the  purifying  power  of 
bacteria  in  the  Illinois  River  and  its  tributaries.  Sam- 
ples were  collected  at  various  points  along  the  Chicago 
drainage  canal  and  the  Desplames,  Illinois,  and  Missis- 
sippi Rivers.  "  In  the  flow  of  twenty-four  miles  between 
Morris  and  Ottawa,  the  river  freed  itself  from  a  great 
mass  of  sewao-e  bacteria  with  which  it  was  originallv 
laden,  and  at  Ottawa  this  was  not  greatly  in  excess  of 
that  found  in  the  flow  of  the  tributary  streams."  He 
attaches  most  importance  to  the  influence  of  sedimenta- 
tion and  to  the  diminution  of  the  food-supply.  Less 
influence  is  believed  to  be  exerted  by  sunlight  and  the 
agencies  of  the  plankton,  the  marine  life  of  the  stream. 
He  believes  that  the  influence  of  the  diminution  of  the 
food-supply  through  the  agencies  of  the  bacteria  them-s 
selves  is  a  factor  that  has  not  received  due  consideration. 

A  very  good  example  of  the  inadequacy  of  the  self- 
purification  of  streams,  in  distances  of  15  to  30  kilo- 
meters, is  afforded  by  the  Merrimac  River,  in  Massachu- 
setts. Epidemics  of  typhoid  fever  have  followed  one 
another,  occurring  first  in  Lowell,  from  two  to  three 
weeks  later  in  Lawrence,  and  in  one  instance  even  in 
Newburyport.  The  refuse  of  one  city  was  carried 
directly  to  the  next,  and  the  lower  cities,  using  the  river- 

1  Jour.  Exper.  Med.,  Dec.  15,  1900. 


ME  THODS  OF  PURIFICA  TION.  115 

water  for  drinking-purposes,  were  afflicted  with  serious 
epidemics.  The  dilution,  sedimentation,  and  aeration 
were  insufficient  to  remove  the  typhoid  bacilli. 

Filtration. — Filtration  is  one  of  the  most  satisfactory 
processes  of  purifying  water.  It  was  formerly  supposed 
that  the  process  was  merely  a  mechanical  one  by  which 
the  particles  suspended  in  the  water  were  removed. 
While  this  is  undoubtedly  true,  it  is  now  well  established 
that,  besides  removing  suspended  particles,  the  filtering 
process  through  properly  constructed  beds  of  sand  will 
diminish  the  amount  of  organic  matter  in  the  water, 
while  the  bacteria  are  very  much  reduced  in  number. 
This  process  is  similar  to  the  natural  processes  of  puri- 
fication constantly  going  on  in  the  soil,  and  is  brought 
about  through  the  activity  of  the  same  agents — the  nitri- 
fying bacteria.  All  well-  and  spring-water,  the  so-called 
ground-waters,  have  been  filtered  by  the  natural  process. 

The  object  of  all  filtration  of  water  is  purification. 
This  purification,  wherever  necessary,  should  be  carried 
out  by  the  municipal  authorities.  In  other  words,  a 
water  should  be  furnished  to  the  public  which  requires 
no  purification  at  the  hands  of  the  citizens  themselves. 

Sand  Filtration. — Filtration  on  a  large  scale,  through 
sand  and  gravel,  was  first  done  in  London,  in  1839,  when 
one  of  the  city  water  companies  subjected  the  water  it  was 
furnishing  to  the  city  to  this  process  in  order  to  remove 
turbidity.  It  is,  however,  only  during  the  last  decade 
that  the  matter  of  sand  filtration  has  received  a  great  deal 
of  attention.  Experiments  have  been  made  on  large  and 
small  scales,  from  which  many  important  facts  regarding 
such  filters  have  been  obtained.  It  has  been  found  that 
even  raw  sewage  can  be  treated  in  this  way  with  remark- 
able results,  and  in  water  98  to  99  per  cent,  of  the  bacteria 
and  a  large  proportion  of  the  organic  matter  are  removed. 

Sand  filtration  is  spoken  of  as  intermittent  or  contin- 
uous, depending  on  the  fact  whether  water  is  kept  on  the 
filter  continuously  or  not.  The  contimious  filter  is  most 
useful  in  the  following  instances:  When  a  city  requires 


1 16  WA  TER  AND   WA  TER-SUPPL  V. 

all  the  water  a  filter  will  take  care  of  when  running  con- 
tinuously; when  the  water  is  not  greatly  polluted;  and 
when  the  conditions  of  temperature  in  winter  are  such  that 
a  certain  amount  of  water  must  be  kept  on  the  filter  bed  in 
order  to  keep  it  from  freezing.  It  has  been  found  that  the 
qualitative  efficiency  of  a  filter  running  continuously  is 
inversely  proportional  to  its  quantitative  efficiency.  In 
other  words,  the  more  rapid  the  rate  of  flow  through  the 
filter,  the  more  impurities  the  filtered  water  will  contain. 

Intermittent  filtratioii  is  resorted  to  when  the  water  is 
highly  polluted.  A  certain  amount  of  air  is  necessary  to 
complete  the  oxidation  of  the  organic  matter.  Highly 
polluted  water  is  deficient  in  dissolved  oxygen,  and  hence 
the  filter  must  be  ventilated  from  time  to  time  to  allow 
the  nitrifying  bacteria  to  recuperate.  When  the  flow  of 
water  is  stopped  the  last  portion  of  water,  as  it  sinks 
down  into  the  filter,  draws  the  air  after  it,  thus  assisting 
in  the  aeration  of  the  filter. 

The  continuous  process  of  sand  filtration  is  used  suc- 
cessfully at  Altona,  Hamburg,  Breslau,  Berlin,  Zurich, 
and  London,  in  Europe,  and  at  Nyack,  Poughkeepsie, 
and  Albany  in  this  country.  In  all  cases  the  European 
rivers  are  polluted  much  more  than  any  of  our  American 
waters.  At  Lawrence,  Mass.,  the  filter  is  worked  inter- 
mittently with  excellent  results. 

The  Lawrence  filter,  which  is  a  type  of  the  slow  sand 
filters,  was  constructed  as  follows:  "A  bed  was  excavated 
to  7  feet  below  water,  about  150  feet  wide  and  750  feet 
long,  close  to  the  Merrimac  River.  The  excavated 
material  that  was  suitable  was  put  into  a  tight  embank- 
ment on  the  ends  and  river-side  of  the  bed,  high  enough 
to  exclude  the  highest  freshet.  The  excavation  was  then 
filled  for  about  5  feet  with  filtering  sand  underdrained  into 
the  old  filtering  gallery  and  into  a  small  perforated  conduit 
in  extension  of  the  gallery.  The  top  of  the  sand,  being 
about  2  feet  below  water,  could  be  flooded  by  gravity  to 
about  2  feet  in  depth,  thus  making  a  shallow  pond  of.  2^ 
acres  area,  which  would  gradually  filter  through  the  sand 


ME  THODS  OF  PURIFICA  HON.  1 1 7 

to  the  underdrains,  and  then  be  conveyed  to  the  old  gal- 
lery and  thence  to  the  pump  well.  Two  sizes  of  sand 
were  selected  after  experimentation,  the  finer  being 
placed  directly  over  the  underdrains,  and  for  5  feet  each 
side  of  them;  and  the  coarser  occupying  the  remaining 
20  feet  between  the  drains,  and  through  which  the  water 
would  move  laterally  and  .use  up  about  the  same  amount 
of  head  as  when  flowing  directly  downward  through  the 
finer  sand.  The  coarser  sand  was  such  that  70,000,000 
gallons  would  flow  in  twenty-four  hours  through  a  foot 
in  depth,  covering  an  acre,  with  the  expenditure  of  1  foot 
head,  and  the  finer  sand  would  convey  50,000,000  gallons 
under  the  same  conditions.  This  filter  being  used  for 
two-thirds  of  a  day  would  furnish  between  4,000,000  and 
5,000,000  gallons  per  day." 

The  Lawrence  filter  removes,  on  an  average,  98. 3  per 
cent,  of  the  bacteria  contained  in  the  river  water.  The 
average  number  of  deaths  in  the  city  from  typhoid  fever 
in  previous  years  had  been  43  for  eight  months,  from 
October  to  May,  while  in  the  first  year  after  starting  the 
filter  there  were  only  16.  Of  the  16  who  died,  9  were 
operatives  in  the  mills,  and  were  known  to  have  used 
unfiltered  canal  water  for  drinking.  In  1898  there  were 
only  8  deaths  from  typhoid  fever,  a  death-rate  of  1.39  per 
10,000  persons  living. 

The  greater  part  of  the  purification  of  water  in  a  sand 
filter  is  believed  to  be  carried  out  on  or  near  the  surface 
of  the  filter.  A  slimy  pellicle  forms  on  the  surface  of 
the  filter  in  a  few  days  after  the  filtration  is  commenced. 
This  pellicle  is  composed  largely  of  so-called  bacterial 
jelly,  and  it  is  the  nitrifying  bacteria  in  this  pellicle  that 
accomplish  the  purification.  The  efficiency  of  a  filter  is 
very  low  until  this  pellicle  has  had  time  to  form,  and 
when  it  is  removed  the  efficiency  of  the  filter  is  destroyed. 
Aside  from  this  surface  film,  or  "  schmutzdecke,"  as  the 
Germans  call  it,  the  individual  sand  grains  in  the  upper 
portion  of  the  filter  are  also  covered  with  a  coating  of  a 
similar  nature. 


nS  WATER  AND   WATER-SUPPLY. 

The  action  of  the  filter  as  a  whole  must  be  taken  into 
account  There  is  undoubtedly  much  mechanical  work 
accomplished  in  the  actual  removal  of  the  larger,  trouble- 
some, but  not  particularly  dangerous  organisms,  and  of 
the  turbidity  and  sediment.  This,  however,  is  not  the 
most  important  action  of  the  sand  filter.  There  is  also 
a  chemical  action  going  on,  an  oxidation  or  burning  up 
of  the  organic  matter,  and  this  is  mainly  due  to  the  vital 
force  in  the  filter — the  nitrifying  bacteria.  These  organ- 
isms appear  to  be  antagonistic  to  water  bacteria  and  to 
pathogenic  organisms  present  in  water,  because  those 
organisms  are  almost  entirely  removed  in  an  efficient 
sand  filter. 

The  changes  which  take  place  in  the  water  as  the 
result  of  filtration  through  a  sand  filter  are  as  follows: 

Removal  of  solids  in  suspension loo  per  cent. 

Reduction  in  free  ammonia 50  to  75        " 

Reduction  in  albuminoid  ammonia 35  to  50       " 

Reduction  in  oxidizable  organic  matter 25  to  30       " 

Increase  in  nitrates 25  to  30       " 

The  rate  of  filtration  should  not  exceed  very  much  1.5 
cubic  meters  per  square  meter  of  surface,  though  it  may 
vary,  according  to  the  relative  purity  of  the  unfiltered 
water,  from  2,000,000  to  5,000,000  gallons  per  acre  daily 
(22,000  to  56,000  cubic  meters  per  hectare). 

The  height  of  water  on  the  sand  filters,  or  the  amount 
of  head,  as  it  is  called,  in  the  continuous  process  of  fil- 
tration varies  according  to  the  practice  which  is  found  to 
give  the  best  results,  the  average  depth  of  water  being 
50  to  75  centimeters,  though  many  of  the  German  filters 
contain  as  much  as  100  to  125  centimeters. 

The  efficiency  of  sand  filters  is  dependent,  to  some 
extent,  upon  the  size  of  the  sand  particles  composing 
the  filter.  The  range  of  the  size  of  the  sand  grains  is 
from  0.09  to  0.38  of  a  millimeter  in  diameter.  Within 
certain  limits,  the  finer  the  sand  particles  the  greater  the 
efficiency  of  the  filter. 

When  first  constructed,  the  thickness  of  the  sand  layer 


METHODS  OF  PURIFICA  TION. 


119 


ranges  from  f  to  \\  meters.  On  account  of  the  process 
of  scraping,  which  is  necessary  to  clean  the  filter  from 
time  to  time,  the  thickness  of  the  sand  layer  is  reduced, 
and  authorities  differ  as  to 
the  extent  of  the  reduction 
that  is  permissible;  some 
allowing  a  reduction  to  a 
depth  of  3  decimeters; 
others  contending  that  the 
reduction  should  never  be 
greater  than  to  6  deci- 
meters before  the  sand  is 
replaced.  In  cleaning  a 
filter  the  surface  slime  is 
taken  off  in  a  thin  layer 
by  means  of  a  scraper. 
This  sand  is  then  removed 
from  the  filter  and  washed 
thoroughly,  when  it  may 
be  used  over  again.  Fig. 
23  shows  a  section  of  a 
covered  sand  filter  such  as 
is  in  use  at  Albany,  N.  Y. , 
and  similar  in  form  to 
those  proposed  for  Phila- 
delphia and  Washington. 

In  cold  climates  it  is 
necessary  to  cover  the 
niters  in  order  to  prevent 
freezing.  In  warm  lati- 
tudes the  filter  should  be 
covered  over  to  prevent 
undue  heating  of  the 
water.  It  is  also  advisable 
to  cover  the  filters  in  order 
to  exclude  sunlight  and 
algae,   and  to  exclude  dust. 

The  efficiency  of  large   sand 


thus 


prevent  the  growth  of 
niters   may  be   demon- 


120  WATER  AND   WATER-SUPPLY. 

strated,  first,  by  a  reduced  mortality  from  typhoid  fever 
and  from  cholera  after  the  introduction  of  the  filter. 
The  efficiency  of  sand  filtration  is  also  demonstrated 
most  graphically  in  the  experience  of  Hamburg  and 
Altona  during  the  cholera  epidemic  of  1892,  both  deriv- 
ing their  water  from  the  river  Elbe;  Altona  taking  its 
supply  below  the  exit  of  the  sewers  of  Hamburg,  but 
filtering  its  water;  Hamburg  using  unfiltered  river- water. 
The  enormous  number  of  cases  of  cholera  and  the 
explosive  outbreak  of  the  disease  in  Hamburg,  and  the 
comparative  freedom  of  Altona,  are  abundant  evidence 
that  the  disease  was  spread  through  the  drinking-water. 
The  bacterial  efficiency  of  sand  filters  ranges  from  98. 1 
to  99.93  per  cent.  The  chemical  efficiency  of  some  of  the 
London  filters  is  such  that  all  of  the  ammonia  is  removed, 
others  removing  from  j$  to  80  per  cent.  In  each  in- 
stance the  total  solids  are  slightly  reduced,  the  organic 
carbon  and  organic  nitrogen  are  uniformlv  reduced; 
showing  that  sand  filtration  effects  an  appreciable  reduc- 
tion in  the  amount  of  organic  matter.  Sand  filtration 
of  water  is  proposed  for  Philadelphia,  Pittsburg,  Wash- 
ington, and  St.  Louis. 

Mechanical  Filtration — Numerous  mechanical  filters 
are  now  on  the  market  which  permit  the  rapid  filtration 
of  large  volumes  of  water  through  limited  sand  areas, 
and,  in  most  instances,  under  considerable  pressure.  A 
number  of  these  mechanical  filters  make  use  of  some 
coagulant,  such  as  alum  or  iron,  in  order  to  assist  in 
clarifying  and  purifying  the  water.  The  flocculent  pre- 
cipitate which  is  formed  takes  with  it  the  suspended 
matters  as  well  as  the  bacteria,  and  the  whole  mass  is 
caught  on  the  surface  of  the  sand  as  the  water  passes 
through.  Usually  these  filters  are  cleaned  by  turning 
the  water  in  the  reverse  direction,  thus  washing  the 
filth,  which  has  accumulated  on  the  sand,  into  the  sewer. 
Small  filters  of  this  nature  are  employed  to  filter  the 
water  of  manufacturing  establishments,  of  hotels,  hos- 
pitals, and  of  private  dwellings  (see  Fig.  24);  larger  sizes 


METHODS  OF  PURIFICATION. 


121 


arranged  in  series,  are  now  also  employed  to  filter  the 
water  of  municipalities  where  the  nature  of  the  impuri- 
ties in  the  water  makes  it  impossible  to  obtain  satisfactory 
results  by  sand  filtration.  Louisville,  Cincinnati,  Provi- 
dence, R.  I.,  Vincennes,  Ind.,  and  Norfolk,  Va.,  have 
filters  of  this  character,  using  alum  as  a  coagulant,  while 
in  Philadelphia  it  is  proposed  to  filter  part  of  the  water- 
supply  by  this  method  and  the  remainder  by  means  of 


K.    Q- 


Fig.  24. — Mechanical  filter:  A,  inlet  pipe;  B,  outlet  pipe;  C,  waste  pipe; 
D,  valve  to  cut  off  water  from  filter;  E,  lever  to  operate  the  agitator;  F,  air 
valve;  H,  handle  of  valve  used  to  change  the  course  of  the  water  through  the 
filter;  I,  distal  attachment  of  coagulating  tank  to  inlet  pipe;  K,  lever  valve 
regulating  the  quantity  of  alum  supplied  ;  O,  proximal  attachment  of  coagulating 
tank  to  inlet  pipe ;  P,  waste  pipe  leading  from  the  coagulating  tank  to  the 
sewer;  Q,  valve  which  fastens  on  the  cover  of  the  coagulating  tank;  S,  pointer 
which  indicates  the  course  of  the  water  through  the  filter ;   T,  sight  glass. 

sand  filters.  A  great  deal  of  objection  has  been  raised 
by  persons  not  fully  informed  on  the  subject,  against  the 
use  of  alum  as  a  coagulant.  If  the  alum  is  used  intelli- 
gently, there  is  not  the  slightest  danger  from  its  use.  It 
is  converted  into  aluminum  hydroxid,  a  white  flocculent 
precipitate,  and' is  retained  on  the  surface  of  the  sand  in 
this  form.  Unless  unusual  amounts  are  used,  none  of  it 
will  be  found  in  the  filtered  water. 


122  WATER  AND   WATER-SUPPLY. 

Another  form  of  mechanical  filter  in  use  is  that  in 
which  spongy  iron  and  scrap  iron  are  used  as  coagu- 
lants. In  these  filters  there  is  an  additional  item  of 
expense  in  the  revolving  machinery  which  is  necessary 
to  agitate  the  iron  in  the  water.  The  scrap  iron  is 
contained  in  a  revolving  cylinder  through  which  the 
water  passes.  After  passing  through  this  cylinder  the 
water  flows  on  to  a  sand  filter.  This  process  is  not 
adapted  to  the  purification  of  brown,  peaty  waters, 
because  the  iron  forms  a  soluble  compound  with  the 
organic  matter  in  these  waters.  A  mechanical  filter 
of  this  kind  has  been  in  successful  operation  at  Wil- 
mington, Del.,  for  some  years,  and  at  Quincy,  111. 

The  nature  of  the  water  and  soil  of  a  locality  influ- 
ences the  kind  of  purification  that  will  be  most  efficient. 
This  can  only  be  determined  by  a  series  of  systematic 
tests.  Such  tests  and  studies  have  now  been  made  at 
Louisville,  Cincinnati,  Providence,  St.  Louis,  Pittsburg, 
and  Lorain,  Ohio,  and  similar  studies  are  now  being  made 
at  Philadelphia. 

No  city  should  be  satisfied  unless  it  possesses  the  best 
possible  water-supply.  The  importance  of  having  a 
good  supply  of  pure  water  must  be  evident.  A  munici- 
pality should  be  compelled  to  furnish  its  citizens  with 
a  water-supply  which  does  not  need  house  filtration  nor 
boiling  to  render  it  safe.  The  insurance  companies 
have  brought  the  matter  to  a  focus  by  making  the  qual- 
ity and  quantity  of  a  municipal  water-supply  one  of  the 
factors  in  determining  the  insurance  rates.  The  life- 
insurance  rates  are  sometimes  increased  if  the  water  is 
polluted,  and  the  fire  rates  are  increased  if  the  quantity 
of  the  general  water-supply  is  considered  insufficient. 
One  or  more  such  cases  of  increased  rates  have  occurred 
recently  in  the  State  of  Indiana.  No  problem  connected 
with  modern  municipal  life  is  of  greater  vital  importance 
than  the  purification  and  protection  of  the  water-supply. 

"  Specifications  for  a  Mechanical  Filter  Plant} — As  it 

1  Engineering  Record,  Nov.  16,  1900. 


ME  THODS  OF  PURIFICA  TION,  123 

is  very  rarely  that  specifications  are  prepared  for  a  large 
municipal  filter  plant,  it  is  believed  that  a  few  extracts 
from  the  set  for  such  works  at  two  of  the  pumping  sta- 
tions of  the  Brooklyn  water-works  will  be  of  general 
interest.  Although  these  specifications  are  signed  by 
Mr.  William  Dalton,  Water  Commissioner,  engineers 
who  are  acquainted  with  the  recent  work  of  the  Mount 
Prospect  Laboratory  will  recognize  that  in  those  portions 
quoted  in  this  article  Mr.  I.  M.  de  Varona  and  Mr.  George 
C.  Whipple  were  the  main  sources  of  inspiration.  The 
filters  on  what  is  known  as  Baiseley's  stream  are  to  have 
a  capacity  of  5,000,000  gallons,  and  those  on  Springfield 
stream  of  3,000,000  gallons;  both  to  operate  by  gravity 
at  a  rate  not  exceeding  125,000,000  gallons  per  acre 
daily.  The  following  extracts  from  the  specifications 
gfive  those  features  which  are  of  most  interest: 

' '  Purification  Required.  — The  purification  required  is 
as  follows: 

"  1.  When  the  applied  water  contains  2500  or  more 
bacteria  per  cubic  centimeter,  there  shall  be  an  average 
reduction  of  bacteria  in  the  filtered  water  from  the  whole 
plant  in  use  of  at  least  98  per  cent. 

"2.  When  the  applied  water  contains  less  than  2500 
bacteria  per  cubic  centimeter,  the  average  number  of 
bacteria  in  the  filtered  water  from  the  whole  plant  in  use 
shall  not  exceed  50  per  cubic  centimeter. 

"3.  When  the  applied  water  contains  2500  or  more 
bacteria  per  cubic  centimeter,  not  more  than  5  per  cent. 
of  the  samples  of  filtered  water  from  the  whole  plant  in 
use  shall  show  a  reduction  of  bacteria  as  compared  with 
the  applied  water  of  less  than  90  per  cent. ;  when  the 
applied  water  contains  less  than  2500  bacteria  per  cubic 
centimeter,  not  more  than  5  per  cent,  of  the  samples  of 
filtered  water  from  the  whole  plant  shall  show  more  than 
75  bacteria  per  cubic  centimeter. 

"4.  When  the  applied  water  contains  2500  or  more 
bacteria  per  cubic  centimeter,  not  more  than  10  per  cent, 
of  the  samples  of  filtered  water  from  any  one  filter  shall 


124  WA  TER  AND   WA  TER-SUPPL  Y. 

show  a  reduction  of  bacteria  as  compared  with  the  ap- 
plied water  of  less  than  90  per  cent. ;  when  the  applied 
water  contains  less  than  2500  bacteria  per  cubic  centim- 
eter,, not  more  than  10  per  cent,  of  the  supplies  of  fil- 
tered water  from  any  one  filter  shall  show  more  than  75 
bacteria  per  cubic  centimeter. 

' '  5.  Not  more  than  5  per  cent,  of  the  samples  of  fil- 
tered water  from  the  whole  plant  in  use  shall  show  a 
reduction  of  microscopic  organisms,  determined  as  stan- 
dard units,  of  less  than  98  per  cent,  as  compared  with 
those  in  the  applied  water. 

"6.  The  filtered  water  shall  contain  no  undecom- 
posed  coagulant  and  no  more  iron  or  aluminum  than  the 
applied  water;  it  shall  not  show  an  acid  reaction,  nor  an 
alkalinity  greater  than  that  of  the  applied  water. 

"Regulation. — The  filters  shall  be  equipped  with  an 
automatic  device  which  will  regulate  the  rate  of  filtra- 
tion, so  that  variations  in  the  same  will  not  exceed  2  per 
cent,  of  the  rate  fixed  and  desired  at  any  time. 

"  Waste. — Separate  pumps  must  be  provided  by  the 
contractor  for  supplying  wash  water;  the  total  amount 
of  water  used  for  washing  and  other  purposes  requiring 
it  to  be  wasted  shall  not  exceed  3  per  cent,  of  the  supply 
filtered. 

"  Tests. — To  determine  whether  the  requirements  have 
been  complied  with,  a  test  of  each  of  the  plants  will  be 
made,  which  test  will  be  begun  as  soon  after  the  filters 
have  been  erected,  connected,  and  placed  in  operation 
as  the  engineer  may  direct,  of  which  date  of  commence- 
ment for  each  station  the  contractor  will  be  duly  advised. 
The  test  of  each  plant  will  extend  over  a  period  of  twelve 
weeks,  and  the  observations  will  be  made  daily  (Sundays 
excepted)  in  periods  of  two  successive  weeks  at  each 
plant,  no  observation  being  taken  at  one  while  they  are 
carried  on  at  the  other,  so  that  the  full  period  devoted 
to  each  will  be  six  weeks.  While  the  tests  are  in  prog- 
ress the  number  of  filters  in  use  at  each  station  shall  bear 
as  near  the  same  proportion  as  possible  (without  exceed- 


ME  THODS  OF  PURIFICA  TION.  125 

ing  the  rate  of  filtration  for  which  the  plant  is  designed) 
to  the  whole  number  of  filters  provided  at  that  point 
that  the  supply  obtained  bears  to  the  full  capacity  of  the 
station  as  herein  specified ;  the  number  of  filters  so  used 
shall  be  understood  to  comprise  the  '  whole  plant ' 
referred  to  under  'purification  required.'  During  the 
test  period  of  each  plant  regular  samples  for  deter- 
mination of  the  contract  requirements  shall  be  taken 
at  such  hours  as  the  engineer  may  elect,  and  as  follows: 

"  {a)  Four  samples  daily  of  the  applied  water,  to  be 
collected  either  from  the  suction  pipes  leading  to  the 
engine,  or  from  the  force  main  leading  to  the  filters. 

' '  {6)  Four  samples  daily  of  the  filtered  water  from  the 
whole  plant,  to  be  collected  either  from  the  main  col- 
lecting flume  or  from  the  discharge  pipe  leading  to  the 
conduit. 

"(V)  One  or  more  samples  of  filtered  water  shall  be 
taken  daily  from  each  of  the  filters,  so  timed  that  they 
will  represent,  as  nearly  as  possible,  the  filtered  product 
of  the  samples  of  applied  water  specified  in  paragraph  a; 
these  samples  shall  be  collected  from  the  outlet  of  the 
filter. 

' '  The  exact  location  of  the  points  from  which  samples 
will  be  collected  will  be  determined  by  the  engineer, 
and  all  necessary  facilities  for  taking  same  will  be  pro- 
vided by  the  contractor. 

<l  Bacterial  determinations  will  be  made  of  each  regu- 
lar sample  taken;  the  number  of  microscopic  organisms 
(standard  units)  in  the  applied  water  and  in  the  filtered 
water  from  the  whole  plant  will  in  each  case  be  deter- 
mined at  least  once  daily,  and  oftener  if  the  engineer 
shall  deem  necessary;  the  iron,  aluminum,  and  alkalin- 
ity will  be  determined  from  regular  or  special  samples, 
and  as  the  engineer  may  deem  necessary;  and  if  unfil- 
tered  water  is  used  for  washing,  the  samples  used  for 
determination  of  iron  will  not  be  taken  until  at  least 
one  hour  after  washing.  Complete  chemical  analyses 
of  the  applied  water  and  of  the  filtered  water  from  the 


126  WATER  AND   WATER-SUPPLY. 

whole  plant  will  be  made  as  often  as  practicable.  All 
collection  of  samples  and  all  of  the  other  observations 
required  will  be  made  under  the  direction  of  the  engi- 
neer and  by  such  of  his  assistants  as  he  shall  see  fit  to 
designate.  The  results  of  the  analyses  and  observations 
thus  made  will  be  used  to  determine  whether  the  require- 
ments of  this  contract  as  to  purification,  use  of  coagulant, 
regulation,  and  waste  have  been  complied  with;  copies 
of  the  results  of  the  examination  will  be  furnished  to  the 
contractor  as  often  as  possible.  The  engineer  shall  adopt 
such  measures  as  he  may  deem  proper  and  necessary  to 
determine  the  amount  of  coagulant  used,  and  the  con- 
tractor will  furnish  all  necessary  facilities  and  appliances 
to  make  such  determinations.  The  method  used  for  the 
collection  of  all  samples  and  for  their  examination  will 
be  open  to  proper  inspection  by  the  contractor,  but  no 
interference  in  such  work  on  his  part  will  be  allowed. 

"The  samples  for  bacteriologic  examination  will  be 
collected  in  sterilized  bottles,  and  plated  as  soon  as  pos- 
sible after  collecting.  The  cultures  will  be  made  upon 
standard  gelatin  that  has  an  acidity  of  1.5  per  cent. 
The  bacteria  will  be  allowed  to  develop  for  about  forty- 
eight  hours  at  a  temperature  at  or  about  200  C. ,  and  for 
as  much  longer  period  as  can  be  obtained  without  lique- 
faction of  the  gelatin.  The  samples  of  applied  water 
and  filtered  water  used  in  determining  the  efficiency  of 
filtration  will  be  cultivated  under  the  same  conditions, 
and  allowed  to  develop  for  the  same  length  of  time. 
Two  or  more  duplicate  plates  will  be  made  for  each 
sample,  and  the  average  of  the  results  will  be  used  to 
determine  the  number  of  bacteria  present  in  the  sample. 
In  case  of  the  loss  of  a  plate  through  the  liquefaction 
of  the  gelatin  or  for  any  other  sufficient  reason,  the 
determination  of  the  efficiency  depending  upon  the  same 
will  be  omitted  from  the  records. 

"The  variation  in  rate  of  filtration,  total  capacity  of 
filters,  and  quantity  of  water  used  for  waste  and  washing, 
shall  be  determined  bv  meter  measurement." 


ME  THODS  OF  PURIFICA  TION. 


127 


Household  Filters. — Household  filters  may  be  divided 
into  two  large  classes,  those  which  filter  all  the  water 
supplied  to  a  house,  as  small  forms  of  the  different  types 
of  mechanical  filters,  and  those  which  filter  only  the 
portion  used  for  cooking  and  for  drinking  purposes.  A 
variety  of  filters  is  now  on  the  market  that  is  intended 
for  this  purpose.  The  essential  characteristics  of  a  good 
filter  of  this  class  may  be  stated  as  follows  : 

A.  With  regard  to  the  filtering  medium: 

1.  It  should  have  sufficient  purifying  power,  mechan- 
ically, to  restrain  all  suspended  matters;  chemically,  to 
remove  dissolved  organic  or  deleterious  matter;  and 
biologically,    to  arrest  micro-organisms. 

2.  This  purifying  power  should  be  reasonably  lasting. 

3.  The  filtering  medium  should  give  up  to  the  water 
nothing  that  is  either  itself  del- 
eterious or  that  will  favor  the 
growth  of  low  forms  of  life. 

4.  The  delivery  should  be 
reasonably  rapid,  consistent 
with  efficient  purification. 

B.  With  regard  to  the  filter 
construction  : 

5.  It  should  be  so  constructed 
as  to  be  easily  taken  apart,  in- 
spected and  cleaned. 

6.  There  should  be  nothing 
that  is  liable  to  decay  or  ca- 
pable of  yielding  up  metallic  or 
other  impurities  to  the  water. 

The  domestic  filters  of  this  class  which  meet  all  these 
conditions  most  satisfactorily  are  the  Berkfeld  filter  (see 
Fig.  25),  composed  of  cylinders  of  baked  infusorial  earth, 
and  the  Pasteur  filter,  composed  of  cylinders  of  baked, 
unglazed  porcelain.  These  filters  yield  a  water  that  is 
clear  and  sparkling,  free  from  bacteria,  and  are  readily 
taken  apart  and  cleansed.  After  having  been  in  use  for 
several  days  the  filtered  water  begins  to  show  the  presence 


Fig. 
Berkfeld : 

to  faucet : 


25. — Domestic    filter — 

a,  point  of  attachment 

b,  outlet. 


128 


WA  TER  AND   WA  TER-SUPPL  Y. 


Fig.  26. — Domestic  water  still. 


of  bacteria  owing  to  the  fact  that  these  organisms  have 
grown  through  the  pores  of  the  filter.  For  this  reason 
these  filters  must  be  cleansed  at  frequent  intervals.  This 
cleansing;  should  consist  in  scrubbing  the  outside  of  the 
cylinder  and  then  boiling  or  baking  for  an  hour.  After 
such  a  cleansing  they  are  almost  as  efficient  as  new 
filters. 

Purification  of  Water  without  Filtration The  proc- 
esses of  purification,   aside  from    filtration,   which   may 

be  employed,  are  distillation, 
boiling,  and  the  treatment 
with  chemical  substances. 
Distillation,  if  properly  car- 
ried out,  furnishes  a  pure 
water.  It  is,  however,  de- 
prived of  its  oxygen  and  car- 
bonic acid,  and  consequently 
it  is  tasteless.  To  remedy  this 
defect  a  number  of  special  dis- 
tilling apparatuses  have  been  devised  which  aerate  the 
water  at  the  same  time  (see  Fig.  26). 

Boiling,  next  to  distillation,  furnishes  a  harmless  water, 
though  it  does  not  remove  the  dissolved  impurities,  and 
at  the  same  time  it  removes  the  gases  dissolved  in  the 
water.  It  renders  the  water  tasteless.  Boiled  water  may 
be  aerated  to  some  extent  by  pouring  it  from  one  vessel 
to  another.  Boiling  removes  the  temporary  hardness, 
the  hydrogen  sulphid,  and  renders  the  dissolved  organic 
matter  and  bacteria  harmless. 

Where  a  water  is  objectionable  merely  on  account  of 
the  bacteria  contained  in  it,  and  there  is  danger  of  con- 
tracting one  or  the  other  of  the  water-borne  diseases,  a 
satisfactory  mode  of  domestic  purification  is  that  by 
means  of  the  Forbes  water  sterilizer  (Figs.  27  and  28),  in 
which  the  water  is  boiled  and  cooled  during  its  passage 
through  the  apparatus,  issuing  from  the  apparatus  with 
its  temperature  but  little  higher  than  at  the  point  of 
entrance. 


METHODS  OF  PURIFICA  TION. 


129 


Fig.  27. — Forbes'  portable  water  sterilizer,  for  use  in  the  absence  of  a  general 
water-supply.  The  raw  water  is  supplied  from  the  inverted  bottle  I.  The 
water  runs  from  the  bottle  I  into  the  cup  2,  then  down  through  the  pipe  3  into 
the  compartment  4  of  the  heat  exchange,  which  it  fills.  When  compartment  4 
is  filled,  the  water  runs  into  the  heater  5,  and  rises  in  the  pipe  6  to  the  level  X, 
where  it  stops.  No  more  water  will  now  run  out  of  the  bottle  I,  because  its 
mouth  is  sealed  by  the  water  in  the  cup  2  at  the  level  X.  The  burner  7  is  now 
lighted,  and  heat  is  applied  under  the  heater  5,  which  causes  the  water  in  the 
heater  to  boil,  and  in  boiling  it  rises  in  the  pipe  6  and  flows  over  into  cup  8, 
just  as  a  pot  on  a  cooking  range  will  boil  over.  It  is  therefore  impossible  for 
any  water  to  pass  through  the  apparatus  until  it  has  boiled,  for  it  is  only  by 
boiling  that  it  can  rise  sufficiently  in  the  pipe  6  to  flow  over  into  the  cup  8.  The 
water  continues  to  boil  over  into  the  cup  8,  and  quickly  fills  compartment  9  of 
the  heat  exchange.  When  compartment  9  is  filled,  the  water  runs  out  of  the 
pipe  11  at  the  opening  12  into  the  receiving  bottle  13.  While  passing  down 
through  the  compartment  9  the  heat  of  the  water,  which  is  boiling  hot,  is  trans- 
ferred, by  conduction,  through  the  thin  metal  partition  or  diaphragm  10  to  the 
cold  water  passing  up  through  compartment  4,  so  that  the  water  which  is  boiled 
in  the  heater  5  passes  out  of  the  apparatus  nearly  as  cold  as  that  entering, 
while  the  cold  water  entering  the  apparatus  becomes  heated  as  it  passes  up 
through  compartment  4,  and  reaches  the  heater  5  nearly  at  the  boiling-point. 

9 


I3P 


WA  TER  AND   WA  TER-SUPPL  Y. 

6. 


Fig.  28. — Forbes'  stationary  water  sterilizer.  The  principle  of  operation  of 
this  apparatus  is  identical  with  that  of  the  apparatus  shown  in  Fig.  27,  but  the 
construction  is  slightly  different.  In  this  apparatus,  I  shows  a  water  tank  with 
a  pipe,  2,  through  which  water  enters,  and  is  allowed  to  fill  the  tank  up  to  the 
water  level  X,  but  no  higher,  as  it  is  restrained  by  the  float-actuated  valve 
shown  in  the  tank. 

The  small  tank  with  the  float  and  valve  merely  take  the  place  of  the  inverted 
bottle  and  aerostatic  feed  used  in  the  first  apparatus.  Both  the  aerostatic 
device  and  the  float  and  valve  have  the  same  functions,  viz.,  maintaining  the 
water  level  at  the  line  X.  In  the  second  apparatus  the  pipe  2  is  connected  with 
a  constant  water-supply,  such  as  a  faucet  or  the  water-supply  pipe  of  the  house. 

After  the  water  leaves  the  float  box  it  runs  down  through  the  pipe  3,  and  the 
action  of  the  apparatus  from  this  point  on  is  exactly  like  that  of  the  porta- 
ble sterilizer  shown  in  Fig.  27. 

The  treatment  of  water  by  means  of  chemical  sub- 
stances is  conducted  with  the  object  of  precipitating 
suspended  matters,  as  by  means  of  the  salts  of  alumi- 
num; the  removal  of  hardness,  by  the  addition  of  lime; 
.to  oxidize  the  organic  impurities  present,  by  the  addition 
of  potassium  permanganate;  the  removal  of  pathogenic 
bacteria,  as  in  the  treatment  with  ozone  or  bromin. 


ME  THODS  OF  PURIFICA  TION.  1 3 1 

Crystallized  alum  is  very  effectual  in  the  precipitation 
of  suspended  matters  in  the  proportion  of  5  or  6  milli- 
grams to  the  liter  of  water.  The  action  is  most  marked 
if  calcium  carbonate  is  present.  Calcium  sulphate  is 
formed,  and  a  bulky  precipitate  of  aluminum  hydoxid 
which  carries  down  the  suspended  matters.  The  water 
may  then  be  filtered  or  on  subsiding  the  clear  water  may 
be  decanted. 

Water  is  softened — that  is,  deprived  of  its  temporary 
hardness — by  the  addition  of  lime-water.  The  lime 
combines  with  the  carbon  dioxid  existing  free  in  the 
water  forming  calcium  carbonate.  This  is  precipitated 
together  with  the  calcium  carbonate  previously  existing 
in  solution,  because  it  is  rendered  insoluble  by  the 
removal  of  the  free  carbon  dioxid.  Carbonate  of  sodium 
is  efficacious  for  softening  water  for  washing  purposes,- 
but  it  is  unsuitable  for  water  used  for  drinking-purposes, 
as  it  gives  the  water  an  unpleasant  taste.  Soda-ash  com- 
bined with  caustic  lime  is  used  for  the  softening-  of  water 
for  boiler  purposes  for  the  removal  of  sulphates  and 
chlorids. 

Potassium  permanganate  removes  offensive  odors  from 
water,  and  to  some  extent  oxidizes  the  dissolved  organic 
matter  present. 

The  use  of  ozone  for  the  purification  of  water  has 
recently  been  advocated.  The  results  obtained  seem  to 
indicate  that  it  has  some  value.  It  was  found  by  Weyl1 
that  95.9  to  99.86  per  cent,  of  the  bacteria  were  destroyed 
in  the  water.  Large  amounts  of  organic  matter  seem  to 
hinder  the  process,  except  when  iron  is  also  added,  when 
the  results  are  quite  satisfactory.  After  being  treated 
with  the  ozone  the  water  is  passed  through  a  rapid  coke 
filter,  from  which  it  issues  perfectly  clear.  The  total 
cost  of  treatment  by  this  method,  including  first  cost,  is 
between  0.5  and  1  cent  per  cubic  meter.  As  to  the 
economic  side  of  the  matter,  Weyl  claims  that  (1)  ozone 
filters  require  very  little  space  as  compared  with  sand 

1  Centralbl.  f.  Bacteriologie,¥>&.  xxvi.,  s.  15 


132  WATER  AND   WATER-SUPPLY. 

filters,  and  their  first  cost  is  much  less;  (2)  the  cost  of 
maintaining  an  ozone  filter  is  less  than  that  of  a  sand 
filter;  and  (3)  the  maintenance  expenses  of  an  ozone 
filter  can  be  still  further  reduced  if  it  is  erected  in  the 
vicinity  of  an  electric  power  station.  The  action  of  the 
ozone  on  the  water  is  a  chemical  one,  and  seems  to  be  of 
value  principally  in  comparatively  pure  waters,  and  not 
in  highly  polluted  waters. 

The  use  of  bromin,  according  to  the  method  of  Schum- 
burg,  consists  in  the  treatment  of  small  quantities  of 
water  by  means  of  a  dilute  solution.  There  should 
appear  in  the  treated  water  a  yellow  color,  remaining  for 
from  two  to  three  minutes.  The  greater  the  degree  of 
hardness,  or  the  larger  the  amount  of  organic  matter  in 
the  water,  the  larger  the  quantity  of  bromin  required  in 
its  sterilization.  The  water  must  be  agitated  so  as  to 
form  a  uniform  mixture,  and  the  excess  of  bromin  must 
be  neutralized  by  means  of  soda  solution.  This  method 
does  not  seem  to  offer  a  very  practical  and  satisfactory 
solution  to  the  problem,  because  it  requires  too  much  care 
and  intelligence  in  its  manipulation. 

Suitability  of  Water  for  Boiler-purposes.  —  The 
suitability  of  water  for  boiler-purposes  is  largely  an  engi- 
neering question,  though  it  is  also  of  importance  to  the 
householder,  because  the  conditions  are  the  same  in  the 
boiler  of  the  kitchen  range  or  of  the  heating  apparatus  as 
in  the  boiler  of  a  manufacturing  establishment.  Water 
may  be  unsuitable  for  boiler-purposes  on  account  of  its 
corroding  action  or  on  account  of  scale-formation.  Water 
of  the  greatest  purity  is  not  always  the  best  for  boiler- 
purposes,  because  of  its  solvent  action  as  water.  This 
corrosive  action  may  be  increased  by  the  oxygen  and  car- 
bon dioxid  in  solution  in  the  water.  The  corrosive  action 
may  also  be  due  to  the  presence  of  organic  and  mineral 
acids  present  in  the  water.  Waters  collected  from  swampy 
regions  are  usually  rich  in  organic  acids,  while  the  waters 
derived  from  mines  are  rich  in  mineral  acids.  Water 
may  also  possess  a  corrosive  action  because  of  the  presence 


WA  TER  AND  SE  WA  GE  ANAL  YSIS.  1 3 3 

of  soluble  chlorids,  especially  sodium  and  magnesium 
chlorids.  Oils  may  also  favor  the  production  of  corro- 
sive substances. 

The  corrosive  action  of  water  may  be  minimized  or 
prevented  by  the  removal  of  turbidity,  by  the  addition  of 
alkalies  to  neutralize  the  acidity,  heating  the  water  to 
drive  off  dissolved  oxygen,  while  the  action  of  the  soluble 
chlorids  may  be  prevented  by  the  addition  of  the  sub- 
stances which  will  be  described  as  useful  in  preventing 
scale-formation. 

The  ingredients  in  water  which  are  most  frequently 
concerned  in  scale-formation  are  the  salts  of  calcium  and 
magnesium.  The  amounts  of  silica  and  iron  are  rarely 
sufficient  to  cause  scale-formation  of  any  note.  The  most 
objectionable  salt  in  water,  with  regard  to  scale-forma- 
tion, is  calcium  sulphate. 

Scale-formation  is  prevented  by  the  neutralization  of 
the  carbon  dioxid  in  the  water.  This  acid  operates  in 
holding  the  calcium  and  magnesium  carbonates  in  solu- 
tion. The  carbon  dioxid  may  be  driven  off  by  heating 
the  water  before  it  passes  into  the  boiler,  so  as  to  precipi- 
tate a  portion  of  the  calcium  and  magnesium.  The  car- 
bon dioxid  may  also  be  neutralized  by  the  addition  of 
slaked  lime  or  caustic  soda  to  the  water.  These  will 
combine  with  the  carbon  dioxid  and  precipitate  it  as  well 
as  the  salts  of  calcium  and  magnesium. 

Standard  Method  of  Water  and  Sewage  Analysis. 
— A  committee  of  the  Section  of  Bacteriology  and  Chem- 
istry of  the  American  Public  Health  Association  made  a 
report  on  the  standard  methods  of  analysis  at  the  annual 
meeting  of  the  Association  at  Indianapolis,  October, 
1900,  of  which  the  following  is  an  abstract  of  the  more 
important  points  involved  : 1 

"  Collection  of  Samples. — Bottles  for  chemical  samples 
should  have  a  capacity  of  1  gallon,  should  be  made  of 
clear  white  glass  in  order  to  facilitate  inspection,  and 
should  have  glass  stoppers.     They  should  be  washed  each 

1  Engineering  Record,  October  27,  1900,  and  November  3,  1900. 


1 34  WA  TER  AND   WA  TER-SUPPL  Y. 

time  before  use  with  sulphuric  acid  and  potassium  bichro- 
mate, or  with  alkaline  permanganate  followed  by  sul- 
phuric acid;  they  should  then  be  thoroughly  rinsed  and 
dried.  For  shipment  the  stoppers  and  necks  of  the  bot- 
tles should  be  protected  with  cloth  tied  over  them.  They 
should  be  packed  in  cases  with  separate  compartments 
for  each  bottle,  and  lined  with  indented  fiber  paper,  felt, 
or  some  similar  substance,  or  provided  with  corner  spring 
strips  to  prevent  breaking.  The  packing  boxes  should 
be  covered  and  provided  with  suitable  fastenings. 

v'  Bottles  for  microscopic  samples  should  have  a  capacity 
of  at  least  i  quart,  and  should  be  of  clear  white  glass, 
but  they  need  not  have  glass  stoppers.  Bottles  for  bac- 
terial samples  should  have  a  capacity  of  at  least  2  ounces, 
and  should  have  wide  mouths  and  glass  stoppers.  Before 
use  they  should  be  washed  as  described  above  and  then 
sterilized  with  dry  heat  for  one  hour  at  1600  C. ,  or  in  an 
autoclave  at  no°C.  for  one-half  hour.  For  transporta- 
tion they  should  be  wrapped  in  sterilized  cloth,  or  the 
neck  should  be  covered  with  tin-foil  and  the  bottles  put 
in  a  tin  box.  When  bacterial  samples  must  of  necessity 
stand  for  more  than  twelve  hours  before  plating,  it  is 
profitable  to  use  larger  bottles  than  2  ounces.  The  gal- 
lon bottle  used  for  the  chemical  sample  may  be  sterilized 
and  used  for  the  entire  analysis.  When  samples  are  not 
plated  at  the  time  of  collection,  they  should  be  kept  on 
ice  at  not  less  than  io°  C.  Portable  ice  boxes  with  sep- 
arate compartments  for  the  ice  and  bottles  may  be  sent 
by  express  with  satisfactory  results. 

"  The  allowable  time  that  may  elapse  between  the  col- 
lection of  a  sample  and  the  beginning  of  its  analysis 
cannot  be  stated  definitely,  as  it  depends  upon  the  char- 
acter of  the  sample  and  other  conditions,  but  the  follow- 
ing limits  are  generally  safe  : 

"  Chemical  analysis.  For  fairly  pure  surface-waters, 
twenty-four  to  forty-eight  hours;  and  for  normal  ground- 
waters, forty-eight  to  seventy-two  hours.  Polluted  water 
requires  analysis  within  twelve  hours. 


WA  TER  AND  SE  WA  GE  ANAL  YSIS.  1 35 

"Microscopic  examination.  For  fairly  pure  waters, 
twenty-four  hours.  If  fragile  organisms,  such  as  uro- 
glena,  synura,  etc.,  are  present,  immediate  examination 
may  be  necessary. 

"  Bacteriologic  examination.  Immediate  plating  is 
always  best,  but  seldom  practicable.  Ordinary  pure 
samples  within  twelve  hours  after  collection  will  not 
introduce  errors  sufficient  to  vitiate  the  results. 

"  Physical  Examination. —  The  physical  examination 
includes  observations  of  the  temperature,  general  appear- 
ance, color,  turbidity,  and  the  odor  in  hot  and  cold  sam- 
ples. 

"The  temperature  should  be  taken  at  the  time  of  col- 
lection, and  expressed,  preferably,  in  centigrade  degrees, 
to  the  nearest  o.  5  degree.  For  obtaining  the  temperature 
of  water  at  various  depths  the  thermophone  gives  the 
most  accurate  results. 

' '  The  general  appearance  of  the  water  should  be  deter- 
mined by  inspection  in  strong  light  after  standing  sev- 
eral hours.  Substances  remaining  in  suspension  are  then 
classed  as  'turbidity  on  standing,'  and  substances  set- 
tling to  the  bottom,  as  'sediment.'  The  terms  'none,' 
'very  slight,'  'slight,'  'distinct,'  'decided,'  etc.,  may 
be  used  for  general  work,  as  described  in  the  reports  of 
the  Massachusetts  State  Board  of  Health.  Where 
methods  are  used  for  expressing  the  turbidity  and  sus- 
pended matters  numerically,  as  is  necessary  with  sewage 
and  some  waters  in  some  lines  of  work,  the  description 
of  appearance  may  be  omitted. 

"At  the  present  time  there  is  no  uniformity  in  the 
methods  of  measuring  turbidity  or  suspended  matter. 
The  wire  method,  the  disk  method,  the  diaphanometer 
method,  the  gravimetric  method,  and  the  use. of  standards 
of  comparison,  all  appear  to  have  their  field  of  useful- 
ness. It  is  desirable  that  some  system  should  be  adopted 
for  making  the  results  by  the  various  methods  compara- 
ble, at  least  for  those  lines  of  work  of  the  same  general 
nature.     In  the  absence  of  the  necessary  experimental 


136  WATER  AND   WATER-SUPPLY. 

data,  your  Committee  is  unable  to  make  a  definite  recom- 
mendation at  present,  although  studies  now  in  hand  will 
probably  make  this  possible  another  year. 

"For  measuring  the  amount  of  dissolved  coloring-- 
matter  in  waters,  the  platinum-cobalt  scale  appears  to  be 
very  generally  used,  although  the  Nessler  and  natural- 
water  standards  and  other  methods  are  being  used  in 
important  work.  While  the  platinum  standard  does  not 
appear  to  be  wholly  satisfactory,  especially  for  very  dark- 
colored  waters,  it  appears  to  be  generally  suitable  for 
ordinary  use,  and  serves  well  as  a  basis  of  comparison 
for  all  results.  Your  Committee  recommends  that  when- 
ever any  other  method  is  used  for  color  measurement  the 
relation  of  this  method  to  the  platinum  standard  shall  be 
indicated.  In  the  case  of  waters  which  are  appreciably 
turbid  the  suspended  matters  should  be  removed  before 
determining  the  color  which  relates  strictly  to  soluble 
matters. 

"The  odor  should  be  observed  in  both  hot  and  cold 
samples,  and  the  results  recorded  in  terms  expressing 
quality  and  intensity,  substantially  as  described  in  the 
paper  on  this  subject  presented  to  this  Section  last  year.1 

"Microscopic  Examination. — The  modified  Sedgwick- 
Rafter  method  appears  to  give  general  satisfaction.  The 
majority  of  analysts  express  the  results  in  '  number  of 
organisms  per  cubic  centimeter,'  but  those  who  have 
had  the  largest  experience  with  the  method  prefer  to 
express  the  results  in  '  number  of  standard  units  per 
cubic  centimeter. '  Inasmuch  as  the  latter  method  takes 
into  account  the  size  of  the  various  organisms,  and  may 
also  be  used  for  the  amorphous  matter,  your  Committee 
favors  the  general  adoption  of  the  standard  unit  method. 

"Chemical  Analysis. — So  far  as  37our  Committee  has 
been  able  to  learn,  the  chemical  methods  used  for  an 
ordinary  sanitary  analysis  of  a  water  do  not  vary  very 
materially  in  those  laboratories  where  most  of  this  work 
is  now  being  done.     As  a  rule,  the  differences  which  are 

1  Trans.  Amer.  Public  Health  Assoc,  p.  587,  1899. 


WA  TER  AND  SE  WA  GE  ANAL  YSIS.  1 3  7 

found  appear  to  be  justified  by  the  differences  in  the 
nature  of  the  waters  and  the  objects  of  the  work.  It 
appears,  however,  from  general  observation,  that  there  is 
room  for  improvement  in  a  number  of  laboratories  in 
which  water  analyses  are  made  in  small  numbers  and  at 
irregular  intervals.  The  determinations  which  from 
general  opinion  are  considered  necessary  for  a  satisfactory 
sanitary  analysis  of  an  ordinary  water  are  as  follows  : 
Residue  on  evaporation,  total  and  dissolved,  with  the 
loss  on  ignition  in  some  instances;  nitrogen  as  albumi- 
noid and  free  ammonia,  nitrites  and  nitrates;  oxygen 
consumed;  chlorin;  and  hardness.  The  general  concen- 
sus of  opinion  regarding  these  determinations  is  quite 
harmonious  on  the  whole,  and  the  best  current  practice 
may  be  outlined  in  brief  terms  as  given  beyond. 

"Within  the  past  few  years  water  analysts  have  had 
occasion  to  study  types  of  water  about  which  very  little 
was  known  a  few  years  ago,  and  to  assist  in  a  variety  of 
special  problems  relative  to  water  pollution  and  various 
processes  for  the  purification  of  both  water  and  sewage. 
Such  investigations  have  naturally  resulted  in  an  in- 
crease in  our  knowledge  concerning  a  number  of  analy- 
tical matters,  about  which  there  was  comparatively  little 
known,  in  practical  terms  in  this  country,  a  dozen  years 
ago.  Among  the  analytical  methods  relative  to  these 
studies,  of  a  more  or  less  special  nature,  may  be 
mentioned  those  for  alkalinity,  iron,  sulphuric  acid, 
carbonic  acid,  and  dissolved  oxygen.  While  the  methods 
for  these  and  other  determinations  have  been  carefully 
worked  out  with  reference  to  certain  conditions  and 
waters  of  certain  types,  it  is  felt  by  the  Committee  that 
there  are  a  number  of  details  which  can  to  advantage  be 
left  in  abeyance  until  another  year.  The  general  trend 
relative  to  these  so-called  special  methods  is  outlined 
briefly  beyond. 

"With  regard  to  the  limits  of  accuracy  of  the  several 
methods  under  various  conditions,  the  determinations 
which   can   be   best   applied    to   various   problems,    the 


138  WATER  AND   WATER-SUPPLY. 

expression  of  the  results  of  analyses,  and  the  interpreta- 
tion of  their  results,  are  all  matters  upon  which  the 
Committee  has  nothing  to  say  until  a  further  expression 
of  experience  and  views  is  received  from  members  of  the 
Section. 

il  Residue  on  Evaporation. — The  amount  of  water  used 
should  be  preferably  such  that  the  residue  will  weigh 
from  3  to  12  milligrams,  although  with  sewages  a  greater 
weight  is  allowable.  Experience  alone  can  indicate  the 
volume  of  water  to  be  taken.  Relative  to  dissolved 
residue,  the  suspended  matter  can  be  satisfactorily  re- 
moved from  surface-waters  of  the  glacial  drift  formation 
and  from  sewages  by  filtration  through  filter-paper.  The 
submicroscopic  clay  particles  of  the  southern  and  western 
waters  can  be  best  removed  by  a  small  Pasteur  filter. 
This  is  not  wholly  satisfactory,  as  in  some  instances 
dissolved  matters  are  absorbed  by  the  filter,  and  in  other 
cases  they  are  removed  from  those  stored  in  the  filter. 
On  an  average  it  yields  fair  results,  "and  no  improvement 
can  be  suggested  at  this  time. 

"With  regard  to  the  use  of  sodium  carbonate,  practice 
varies;  but  it  would  seem  to  be  wise  to  add  it  (with  a 
deduction  from  total  weight)  to  those  waters  and  sewages 
in  which  it  is  of  value  to  obtain  the  loss  on  ignition. 
Evaporation  is  almost  invariably  obtained  in  a  steam 
bath  at  a  temperature  of  nearly  ioo°  C.  The  loss  on 
ignition,  it  is  believed,  can  be  secured  best  with  the  use 
of  a  radiator,  in  accordance  with  Drown' s  suggestions, 
although  this  device  is  not  in  general  use.  In  fact,  there 
is  a  growing  tendency  among  workers  to  omit  this  deter- 
mination, except  for  sewages  and  those  waters  relatively 
high  in  organic  matter. 

"  Chlorin. — This  is  determined  always  by  titration 
with  a  standard  solution  of  silver  nitrate,  using  potassium 
chromate  as  an  indicator.  Colored  surface-waters  first 
require  decolorization  by  the  addition  of  aluminum  hy- 
drate. The  volume  of  water  taken  depends,  of  course, 
upon  the  amount  of  chlorids  present.     With  unpolluted 


WA  TER  AND  SE  WA  GE  ANAL  YSIS.  I 39 

surface-waters  in  the  East  from  200  to  250  cubic  centi- 
meters should  be  concentrated  by  evaporation.  In  the 
case  of  sewages  and  highly  polluted  water  containing 
much  organic  matter  satisfactory  results  can  be  obtained 
by  evaporation  to  dryness,  ignition  of  the  residue,  and 
subsequent  solution  of  the  chlorids  with  hot  distilled 
water.  The  titrations  should  be  regularly  made  with 
volumes  substantially  the  same  as  employed  in  the  stand- 
ardization of  solutions. 

"Nitrogen  as  Free  and  Albuminoid  Ammonia. — The 
volume  of  ordinary  water  taken  for  distillation  is  500 
cubic  centimeters,  and  with  very  highly  polluted  waters 
or  sewages  smaller  quantities  are  taken  and  diluted  to 
the  above  amount  with  ammonia-free  distilled  water. 
Where  many  sewages  are  analyzed,  the  volume  taken 
may  be  10  cubic  centimeters  or  less,  in  accordance  with 
Hazen's  method.  As  a  general  rule,  it  seems  advisable 
to  add  a  few  drops  of  a  saturated  solution  of  sodium  car- 
bonate before  distillation.  It  is  advisable  to  collect  the 
distillate  in  the  Nessler  tubes  in  which  this  color  is  to  be 
read.  The  rate  of  distillation  should  be  50  cubic  centim- 
eters in  five  or  six  minutes.  It  is  an  almost  universal 
custom  to  collect  3  tubes  of  50  cubic  centimeters  each 
for  the  free  ammonia,  and  5  tubes  for  the  albuminoid 
ammonia.  In  regard  to  the  preparation  of  alkaline  per- 
manganate and  Nessler  solutions,  the  directions  in  any 
good  text-book  may  be  followed,  and  the  individuality 
of  various  workers  in  these  particulars  is  apparently  not 
a  factor  affecting  unfavorably  the  accuracy  of  results. 
Both  the  distillates  and  the  standard  ammonia  solutions 
should  be  of  the  same  temperature  before  the  addition 
of  the  Nessler  solution. 

"Nitrogen  as  Nitrites. — No  method  superior  to  the 
Warrington  modification  of  the  Griess  method  is  now 
known  ] 

"Nitrogen  as  Nitrates. — The  determination  of  nitro- 
gen  as   nitrates    is    made    almost    exclusively   by    two 

1  See  Special  Report  of  the  Mass.  State  Board  of  Health,  Part  II.,  1890. 


140  WATER  AND   WATER-SUPPLY. 

methods,  the  phenol-sulphonic  acid  method  of  Grandval 
and  L,ajoux,  and  the  aluminum  reduction  method.  With 
waters  comparatively  high  in  nitrates,  and  if  a  good 
brand  of  nitrogen-free  caustic  soda  can  be  obtained,  the 
aluminum  method  is  more  easily  worked,  and  gives 
better  average  results.  With  waters  low  in  nitrates  and 
low  in  chlorin  the  phenol-sulphonic  acid  method  gives  as 
good  or  better  results  than  the  reduction  method.  It  is 
intended  to  consider  the  comparative  merits  of  the  two 
methods  in  detail  in  the  later  report. 

"  Oxygen  Consumed. — Practice  varies  widely  both  here 
and  abroad  with  reference  to  the  method  for  this  deter- 
mination; and  many  analysts  omit  it  from  the  analyses 
of  certain  types  of  water.  For  sewages  and  those  waters 
which  are  high  in  organic  matter  it  undoubtedly  yields 
valuable  information.  It  would  appear  advisable  to 
adopt  a  uniform  procedure  intermediate  between  the 
wide  extremes  now  practised.  Such  would  be  afforded 
by  the  addition  of  the  reagents  to  the  water  when  cold, 
and  boiling  for  five  minutes. 

"Hardness. — For  ordinary  sanitary  work  the  soap 
method  is  commonly  used,  and  for  the  soft  eastern  waters 
it  appears  to  give  reasonably  satisfactory  results.  For 
the  hard  waters  of  the  West  Hohner's  acid  method  is 
preferred.  There  are  some  details  connected  with  the 
determination  of  the  permanent  hardness  by  the  Hohner 
method  which  require  further  study. 

"Alkalinity. — This  determination  can  be  satisfactorily 
made  by  Hohner's  method.  Methyl-orange  is  used  by 
some  workers  as  an  indicator,  while  recent  comparative 
studies  give  the  preference  to  lacmoid  or  erythrosin.  The 
latter  indicators  have  the  advantage,  in  connection  with 
the  use  of  coagulants,  of  affording  the  most  reliable  test 
for  the  presence  of  undecomposed  alum  in  water. 

"Relative  to  the  latter  point,  the  logwood  test  is  con- 
sidered satisfactory  by  some  workers,  while  by  others  it 
seems  to  be  more  of  a  qualitative  test  than  a  quantitative 
one.     The  differences  in  opinion  are  very  likely  due  to 


WATER  AND  SEWAGE  ANALYSIS.  141 

unappreciated  differences  in  manipulation  which  require 
further  study. 

"Iron. — There  are  evidently  several  methods  of  an 
allied  nature  which  can  be  used  successfully  for  this 
determination,  provided  they  are  carefully  applied.  In 
another  report  the  Committee  can  probably  give  a  graded 
set  of  procedures  applicable  to  various  conditions  of 
practice.  Thompson's  method,  as  described  in  Sutton's 
Volumetric  Analysis,  appears  to  be  most  generally  used. 

"  Sulphuric  Acid. — Wildenstein's  method  as  described 
by  Ohlmuller  has  proved  very  satisfactory  for  certain  lines 
of  work,  and  is  preferable  to  the  gravimetric  method. 
Whether  or  not  this  is  true  under  a  wide  range  of  condi- 
tions remains  to  be  seen. 

"Carbonic  Acid. —  For  eastern  waters  Pettenkofer's 
method  as  described  by  Sutton  is  considered  to  be  gen- 
erally satisfactory;  while  for  the  western  waters  Trillion's 
modification  of  this  method,  as  described  by  Ohlmuller, 
is  preferred  by  some  workers.  This  method  gives  both 
the  free  and  half-combined  carbonic  acid.  There  is  a 
growing  tendency  among  chemists  to  attach  the  more 
importance  to  the  free  carbonic  acid  alone.  This  can  be 
obtained  differentially  by  the  method  by  which  the  free 
carbonic  acid  is  removed  by  the  passage  of  the  water 
through  a  tube  containing  small  gravel  stones,  with  a 
current  of  air  drawn  in  the  opposite  direction.  Further 
study  of  this  entire  subject  will  place  it  on  a  more  sub- 
stantial basis. 

"Dissolved  Oxygen.  —  There  appear  to  be  several 
methods  which  can  be  used  successfully  for  this  determi- 
nation. The  method  in  most  general  use,  however,  is 
that  of  Winkler  as  described  in  the  Special  Report  of  the 
Massachusetts  State  Board  of  Health,  Part  I.,  1890. 

"By  the  way  of  general  comment,  it  may  be  added 
that  recent  developments  in  sewage  purification  have 
indicated  the  desirability  of  special  attention  to  several 
matters.  Among  them  is  the  advantage  coming  from  a 
more  general   use   of  the    determination    of    suspended 


142  WATER  AND   WATER-SUPPLY. 

matters  in  sewage,  with  the  loss  on  ignition.  Another 
point  is  the  desirability  of  determining  the  organic  nitro- 
gen in  unpurified  sewage  by  the  Kjeldahl  method,  in 
view  of  the  varying  percentage  of  this  constituent  which 
is  afforded  by  the  albuminoid  ammonia.  The  so-called 
'incubation-test,'  to  show  the  relation  to  putrefaction  of 
sewage  after  purification,  seems  to  have  much  practical 
value  under  certain  conditions,  although  the  details  can- 
not be  considered  at  this  time. 

"  Quantitative  Bacterial  Examinations.  —  With  refer- 
ence to  this  subject,  there  has  recently  been  a  marked 
improvement  in  the  general  results  obtained  in  this 
country.  It  is  true,  however,  that  methods  of  different 
workers  are  still  variable  to  a  degree  which  seems  unneces- 
sary, and  which  is  certainly  not  desirable,  when  we  con- 
sider that  the  value  of  this  class  of  data  relates  largely  to 
purposes  of  comparison. 

"  The  culture-medium  now  in  general  use  is  nutrient 
gelatin,  prepared  substantially  as  recommended  by  the 
Bacteriologic  Committee  in  their  report  of  1897.  Meat- 
extract,  however,  is  still  used  by  a  number  of  workers  in 
place  of  meat-infusion.  Data  are  lacking  to  justify  this 
as  a  general  procedure.  For  some  special  lines  of  work 
nutrient  agar  is  used  with  apparent  advantage.  These 
conditions  refer  to  analyses  of  decomposed  or  stale 
sewage,  where  the  number  of  bacteria  capable  of  rapid 
liquefaction  of  gelatin  is  very  large;  and  also  to  certain 
lines  of  field  work.  Several  investigators  have  tried 
media  of  modified  composition,  containing  new  ingre- 
dients in  some  instances,  but  the  present  evidence  is  alto- 
gether too  inconsistent  and  indefinite  to  permit  of  any 
recommendations  along  this  line. 

"Concerning  the  reaction  of  the  nutrient  gelatin,  the 
optimum  varies  under  different  conditions.  Speaking  in 
general  terms,  the  majority  of  waters  now  studied  appear 
to  require  ordinarily  about  1  per  cent,  of  acid.  There 
are  some  waters  for  which  this  reaction  is  too  acid,  and 
the  sewaee  of  some  manufacturing  cities  evidently  re- 


WA  TER  AND  SE  WAGE  ANAL  YSIS.  143 

quires  an  alkaline  medium.  For  important  continuous 
work  the  reaction  to  be  used  should  be  carefully  worked 
out  with  reference  to  the  local  conditions. 

"The  amount  of  agitation  which  the  sample  of  water 
should  receive  before  plating,  in  order  to  insure  mixing 
and  a  separation  to  a  reasonable  degree  of  groups  of  bac- 
teria, is  afforded  by  twenty-five  vigorous  shakes  of  the 
partially  filled  sample  bottle. 

"  Most  workers  arrange,  so  far  as  practicable,  to  have 
not  more  than  about  200  colonies  on  the  ordinary  plate, 
such  as  Petri  dishes  having  a  diameter  of  about  4  inches. 
For  those  waters  in  which  such  numbers  of  bacteria*  are 
contained  in  small  fractions  of  1  cubic  centimeter,  it  is 
the  general  practice  to  dilute  them  with  sterilized  water, 
rather  than  to  use  pipets  delivering  small  fractions  of  1 
cubic  centimeter. 

"The  amount  of  nutrient  gelatin  used  for  each  plate 
ranges  at  different  laboratories  from  5  to  10  cubic  centim- 
eters. Most  workers  use  more  than  7,  while  in  some 
of  the  largest  laboratories  the  quantity  is  5  cubic  centim- 
eters. For  results  to  be  obtained  after  four  or  more 
days  of  cultivation  the  larger  quantity  is  doubtless  pref- 
erable. For  results  to  be  obtained  after  two  days'  growth 
5  cubic  centimeters  are  found  to  be  more  satisfactory. 

' '  Practice  varies  with  reference  to  mixing  the  water 
and  the  gelatin  in  the  tube  or  on  the  dish,  in  those  cases 
in  which  Petri  dishes  are  used.  There  are  no  evidences 
to  indicate  that  this  is  a  point  of  much  practical  signifi- 
cance, affecting  results  beyond  the  ordinary  limits  of 
accuracy. 

"With  regard  to  standard  conditions  of  cultivation, 
the  best  available  evidence  shows  that  it  should  take 
place  in  the  dark  and  in  an  atmosphere  in  which  moisture 
and  oxygen  are  always  present.  Petri  dishes  sometimes 
fit  too  tightly  to  give  satisfactory  results,  and  special 
attention  is  necessary  to  these  particulars.  The  tempera- 
ture of  cultivation  should  be  uniformly  200  C. ,  and  it  is 
gratifying  to  note  that  in  many  laboratories  this  standard 


144  WA  TER  AND   WA  TER-SUPPL  Y. 

has  been  adopted,  notwithstanding  the  care  and  expense 
which  it  sometimes  involves. 

"The  period  of  cultivation  still  varies  considerably  in 
the  different  laboratories.  There  is  a  well-defined  move- 
ment, however,  toward  shorter  periods,  in  order  to  secure 
greater  practical  value  for  the  data.  These  practical 
advantages  outweigh  the  smaller  numbers  obtained  from 
a  shorter  period,  especially  as  all  results  have  only  a 
relative  and  not  an  absolute  value.  In  Germany  forty- 
eight  hours  is  the  standard  period  of  cultivation,  and 
daily  results  have  been  obtained  on  this  basis  from  each 
of  26  water  purification  plants  in  operation  in  that 
country.  There  seems  to  be  no  good  reason  why  the 
bacterial  results  to  be  obtained  from  the  various  water 
purification  plants  now  in  operation  and  about  to  be  built 
in  this  country  should  not  be  comparable  with  those 
obtained  abroad.  This  is  especially  true  in  view  of  the 
growing  appreciation  of  the  fact  that  the  residual  num- 
bers of  bacteria  in  a  filtered  water  should  receive  atten- 
tion as  well  as  the  percentage  of  bacterial  removal. 
Taking  everything  into  consideration,  it  would  appear  to 
your  Committee  to  be  advisable  to  adopt  forty-eight 
hours  as  a  standard  period  of  cultivation  under  the  con- 
ditions noted  above.  Before  making  a  final  recommenda- 
tion there  is  requested  a  further  expression  of  opinion  on 
the  part  of  the  members  of  the  Section  of  Bacteriology 
and  Chemistry." 

The  Committee  on  Standard  Methods  of  Water  and 
Sewage  Analysis  appointed  by  the  American  Public 
Health  Association  gives  the  following  summary  : 

' '  On  the  Present  Status  of  Methods  of  Purification  of 
Water-supplies,  with  a  Summary  of  Plants  in  Operation 
in  America} — Of  the  various  branches  of  public  works 
connected  with  the  pollution  of  water-supplies,  there  is 
none  in  which  such  substantial  progress  has  recently 
been  made  as  in  water  purification.  Ten  years  ago  our 
information  upon  this  subject  was  very  meager,  and  com- 

1  Engineering  Record,  November  3,  1900. 


METHODS  OF  WATER  PURIFICATION.  145 

paratively  few  plants  were  in  operation.  During  this 
period  English  sand-filter  plants  have  been  increased 
from  about  1.5  to  19  acres,  with  respective  nominal 
capacities  of  about  4  and  57  million  gallons  daily;  and 
the  American,  or  mechanical  filter,  plants  have  been 
increased,  from  about  12,000  to  90,000  square  feet,  with 
respective  nominal  capacities  of  about  36  to  270  million 
gallons  daily.  Projected  plants  for  some  of  the  largest 
cities  in  the  country  show  that  in  the  next  few  years 
there  will  be  very  rapid  development  in  the  application 
of  both  of  the  leading  methods  of  purification. 

"  Concerning  the  large  fund  of  technical  knowledge 
relative  to  the  efficiency  and  cost  of  water  purification 
which  is  readily  available  from  various  books,  reports, 
and  professional  and  technical  journals,  it  is  needless  to 
touch  upon  them  in  this  report  of  progress.  An  ade- 
quate statement  of  the  general  situation  at  this  time  will 
be  found  in  the  paper  by  Mr.  Allen  Hazen.  With  regard 
to  the  leading  generalizations  which  can  be  made  at  this 
time,  workers  in  this  subject  agree  upon  the  following  : 

"  1.  Of  the  various  processes  mentioned  for  the  purifi- 
cation of  water-supplies,  there  are  two  general  methods 
which  have  shown  distinctly  their  practicability,  namely, 
the  English  method  of  slow  sand  filtration  and  the 
American  method  employing  rapid  mechanical  filters. 

"  2.  Each  of  these  methods  has  its  distinct  advantages 
for  particular  cases,  as  well  as  its  distinct  disadvantages 
for  others;  and  there  is  no  doubt  that  each  has  a  large 
field  of  usefulness. 

"3.  For  those  waters  which  never  possess  more  than 
a  slight  or  moderate  amount  of  turbidity  or  dissolved 
vegetable  color,  the  English  method  of  sand  filtration  is 
somewhat  more  efficient;  and,  as  a  rule,  it  is  slightly 
cheaper  for  such  waters. 

"  4.  For  those  waters  which  for  long  periods  at  a  time 
contain  excessive  quantities  of  either  finely  divided  clay 
or  of  dissolved  vegetable  matter,  there  is  now  no  prac- 
ticable method  of  purification  without  the  use  of  coagu- 

10  c 


146  WATER  AND   WATER-SUPPLY. 

lant  and  subsiding  basins.  It  is  the  consensus  of 
opinion,  however,  that  coagulants  should  not  be  em- 
ployed where  it  is  practicable  to  secure  satisfactory 
results  without  them. 

"  5.  While  coagulants  can  be  successfully  used  in  con- 
nection with  the  English  method  of  sand  filtration,  in 
those  cases  in  which  coagulants  are  imperative  the 
American  method,  as  a  rule,  yields  somewhat  more 
efficient  and  economical  results. 

"6.  Many  of  the  purification  plants  now  in  operation 
in  this  country  have  not  shown  as  high  efficiency  as  is 
reached  by  a  few  of  the  better  ones,  and  as  may  be 
expected  from  those  now  about  to  be  built.  This  is  due 
in  part  to  their  construction,  and  in  part  to  their  manage- 
ment, the  latter  point  applying  particularly  to  mechani- 
cal filters. 

"7.  While  there  has  been  rapid  progress  in  the  past 
few  years  in  discovering  the  controlling  laws  of  purifica- 
tion and  in  the  establishment  of  certain  types  of  filters, 
there  are  indications  which  go  to  show  that  material 
progress  and  improvement  may  be  expected  for  some 
time  to  come." 


CHAPTER     V. 
THE   REMOVAL   AND   DISPOSAL   OF   SEWAGE. 

The  term  sewage  includes  not  only  human  excreta, 
solid  and  liquid,  but  also  the  waste  water  and  impurities 
coming  from  human  habitations.  The  term  sewage, 
however,  does  not  include  such  impurities  as  proceed 
from  manufactories,  such  as  the  refuse  from  dye-works, 
gas-works,  etc. ;  these  are  termed  manufacturing  impuri- 
ties. From  a  hygienic  standpoint  the  human  excreta 
are  the  most  important  constituents  of  sewage.  The 
sewage  of  towns  usually  contains,  besides  human  excreta 
and  household  wastes,  the  water  used  for  washing  and 
sprinkling  streets,  as  well  as  the  rain  that  falls  which  is 
not  stored  for  household  use.  The  total  quantity  of 
sewage  depends  largely  upon  the  amount  of  pure  water 
supplied  per  head  per  day.  Sewage  has  an  average  com- 
position of  998  parts  of  water,  1  part  of  urine,  and  1 
part  of  organic  matter. 

The  Removal  of  Sewage. — The  removal  of  sewage 
from  the  dwelling  is  accomplished  by  several  different 
methods.  That  in  general  use  in  towns  is  by  means  of 
water.  This  system  necessitates  the  introduction  of 
the  necessary  waste  pipes  for  the  removal  of  the  sewage 
itself,  the  introduction  of  a  supply  of  water  sufficient  to 
flush  out  the  drain  pipes  and  keep  them  free  from  sewage. 
It  also  necessitates  arrangements  for  the  disposal  of  the 
sewage. 

Water-closets. — In  the  removal  of  sewage  by  means 
of  water  the  water-closet  forms  a  most  important  factor 
in  the  system.  The  qualities  required  by  all  the 
appliances  of  a  water-closet  are  durability,  simplicity, 
accessibility,  cleanliness,  and  general  effectiveness.     The 

147 


148   THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

old-style  pan  closet  (Fig.  29)  is  no  longer  in  use.      The 
principal  forms   of  closet  that  are  now  in  use  are  the 


Fig.  29. — Pan  closet. 


hopper  (Fig.  30),  some  form  of  wash-out  or  wash-down 
closet   for    private    dwellings    (Figs.    31,    32),    and    the 


Fig.  30. — Hopper  closet. 


Fig.  31. — Wash-out  closet. 


trough  closet  or  latrine  for  schools  and  public   institu- 
tions. 


WA  TER-  CL  OSE  TS. 


149 


The  supply  of  water  for  the  wash-down  closet  consists 
of  the  introduction  of  a  separate  cistern,  used  exclusively 
for  the  water-closet,   generally    termed  a   ' '  water-waste 


FlG.  32. — -Wash-down  closet. 


preventer"  (Fig.  33),  because  only  a  limited  supply  of 
water  is  available  for  delivery.  The  amount  of  water 
usually  supplied  in  the  cistern  is  about  15  liters.     The 


FlG.  33. — Water-waste  preventer. 

cistern  is  placed  at  some  height  (not  less  than  a  meter) 
above  the  closet,  and  has  an  exit  pipe  of  considerable 
size,  so  that  the  water  may  descend  with  sufficient  force 
to  flush  effectually  the  closet. 


150  THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

The  position  of  the  closet  chamber  is  of  importance. 
It  should  always  be  arranged  along  the  outer  wall  of  a 
building,  so  as  to  afford  ventilation  into  the  open  air,  and 
not  into  an  air  shaft.  The  closet  itself  should  be  along 
the  inner  wall,  opposite  a  window,  so  as  to  afford  plenty 
of  light  to  detect  any  defects. 

The  arrangement  of  a  modern  bath-room,  in  which  all 


Fig.  35. — S-trap. 


Fig.  36. — Bell-trap. 


Fig.  37. — Anti-D  trap. 

the  modern  improvements  in  the  sanitary  removal  of 
sewage  are  supplied,  is  shown  in  Fig.  34.  In  the  modern 
dwellings  now  being  constructed  the  conveniences  sup- 
plied in  bath-rooms  are  important  factors  in  conserving 
the  health  of  the  individual  as  well  as  of  the  community. 
Traps. — A  trap  is  a  bend  in  the  pipe  which  is  filled  with 
water  so  as  to  prevent  the  entrance  of  sewer  or  drain  air 
into  the  house.      It  consists  of  a  water  seal  in  the  pipe. 


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151 


All  appliances  on  the  drainage  pipes  of  a  house,  such  as 
water-closets,  sinks,  etc.,  must  be  supplied  with  a  trap. 
The  different  forms  of  traps  in  use  are  the  S-trap,  the 


Fig.  38. — Mason's  trap. 

bell- trap,   the  anti-D   trap,   and  Mason's  trap  (Figs.   35, 

36,  37,  and  3s)- 

Soil  Pipe. — The  pipes  for  carrying  away  the  sewage 


Fig.  39. — Method  of  connecting  soil  pipe  with  house  drain. 

from  a  house  are  called  soil  pipes.  For  an  ordinary  dwell- 
ing the  soil  pipes  should  be  constructed  of  heavy  iron 
tubing,  with  tight  joints,  circular  in  shape,  and  10  centim- 
eters in  diameter.  The  interior  of  the  soil  pipe  must  be 
smooth,  so  as  not  to  impede  the  flow  of  the  sewage.  The 
soil  pipe  is  ventilated  through  the  warming  of  its  contained 
air,  causing  an  upward  current,   the   fresh   air  entering 


152    THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

through  a  ventilator  opening  on  the  outside  of  the  house 
next  the  point  of  disposal,  and  takes  its  exit  through  the 
upper  end  of  the  pipe,  which  is  carried  up  over  the  roof 
of  the  building.  The  soil  pipe  should  have  an  S-shaped 
trap  between  the  ventilator  opening  and  the  sewer.  All 
connections  of  drainage  pipes  with  the  soil  pipe  must  be 
absolutely  tight,  and  should  be  made  at  an  acute  angle, 
not  at  a  right  angle  with  the  soil  pipe  (Fig.  39). 

Where  several  closets  on  different  floors  discharge  into 


Fig.  40. — Arrangement  of  soil  pipe. 


the  same  soil  pipe,  the  suction  of  the  water  in  the  soil 
pipe  causes  the  trap  of  the  other  closet  to  become  un- 
sealed. To  obviate  this  defect  the  traps  are  supplied 
with  a  separate  ventilating  pipe  of  small  diameter,  which 
enters  into  the  soil  pipe  above  the  highest  appliance  of 
the  system.  These  extra  pipes  also  serve  to  ventilate  the 
traps  and  pipes,  and  for  this  reason  this  is  frequently 
spoken  of  as  the  "back-airing"  of  traps.      It  serves  to 


DR  Y  ME  THOD  OF  SE  WA  GE  RE  MO  VAL. 


J53 


supply  fresh  air  to  the  pipes,  and  thus  serves  to  prevent 
the  growth  of  anaerobic  bacteria  in  the  unventilated  por- 
tion of  the  traps.  By  this  means  the  generation  of  disa- 
greeable odors  is  prevented.  The  method  of  ventilation 
of  soil  pipe  and  the  traps  is  represented  in  Fig.  40. 

The  required  amount  of  fall  for  house  drains  may  be 
determined  according  to  the  following  rule:  Multiply  the 
diameter  of  the  drain  in  centimeters  by  4;  thus  a  10- 
centimeter  drain  should  have  a  fall  of  1  in  40;  a  15-centim- 
eter drain  1  in  60,  and  so  on.     If  the  distance  from  the 


Fig.  41. — Dry-earth  closet. 

appliance  to  the  soil  pipe  is  too  great  to  obtain  the 
requisite  amount  of  fall  in  the  limited  space  between 
floor  and  ceiling,  it  will  be  necessary  to  have  extensions 
from  the  soil  pipe  from  the  basement  to  the  roof  to 
receive  these  drains. 

Another  method  of  sewage  removal  is  usually  spoken 
of  as  the  dry  method.  The  pail  system  and  the  dry- 
earth  closet  are  the  principal  types  of  the  dry  methods  of 
sewage  removal.  In  the  pail  system  the  excreta  are 
simply  received  in  boxes  or  tanks,  and  these  are  emptied 
whenever  necessary.      In  the  dry-earth  closet  a  receptacle 


154   THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

containing  dry  earth  is  placed  in  the  closet  and  about 
^  kilogram  of  dry  earth  is  thrown  over  each  evacua- 
tion (Fig.  41).  The  earth  is  a  natural  deodorizer  and  the 
mass  remains  inoffensive  for  a  long  time,  the  fecal  matter 
being  finally  entirely  disintegrated.  A  separate  recepta- 
cle is  supplied  for  the  collection  of  the  urine.  This  sys- 
tem is  the  least  objectionable  in  such  localities  where  a 
general  water-supply  is  not  available,  or  where  the 
climate  is  too  severe  to  render  a  water-closet  safe  and 
serviceable. 

Disposal  of  Sewage. — The  question  of  the  disposal 
of  sewage  is  distinct  from  that  of  sewage  removal,  but 
the  method  of  disposal  is  dependent,  to  some  extent, 
upon  the  method  of  removal.  In  the  dry  methods  of 
removal  the  final  disposal  of  the  fecal  matter  is  as  fertil- 
izer upon  cultivated  land.  If  the  removal  is  by  means 
of  water,  this  will  be  either  partial,  as  to  a  cesspool,  and 
hence  further  removal,  after  longer  or  shorter  intervals, 
as  well  as  final  disposal,  may  be  necessary,  or  the  removal 
may  be  partial  through  a  sewerage  system  and  final  dis- 
posal into  streams  or  large  bodies  of  water,  treatment  by 
precipitation  processes,  or  by  the  various  methods  of 
purification. 

In  rural  districts  where  there  is  no  general  sewerage 
system  the  house  drains  usually  discharge  into  cesspools 
or  tanks  for  the  storage  of  sewage.  Cesspools  differ  in 
their  construction  and  mode  of  operation  according  to 
the  nature  of  the  soil  in  which  they  are  located.  Where 
the  soil  permits  and  the  amount  of  space  is  sufficient, 
the  cesspool  may  be  constructed  so  as  to  allow  the  fluid 
portion  of  the  sewage  to  drain  away  at  once.  Where  no 
wells  are  near  enough  to  be  affected  by  this  process  the 
cesspool  may  operate  for  a  long  time  without  being 
cleaned  out.  Where  the  nature  of  the  soil  does  not 
permit  this  mode  of  disposal  of  the  fluid  portion  of  the 
sewage,  or  where  there  is  danger  of  infecting  neighbor- 
ing wells,  the  cesspool  should  be  so  constructed  as  to  be 
impervious.       Under    these    conditions    it   will    require 


CHEMICAL  TREA  TMENT  OF  SE  WAGE  155 

frequent  cleansing,  the  contents  removed  serving  as 
fertilizer.  Such  a  cesspool  should  be  removed  from  the 
house  and  well  as  far  as  possible,  and  in  such  a  position 
that  the  flow  of  the  ground  water  is  always  in  the  direc- 
tion from  the  well  toward  the  cesspool. 

A  large  majority  of  towns  discharge  their  sewage  into 
neighboring  streams.  All  new  works  of  this  nature  are 
prohibited  in  England.  In  Ohio  the  State  Board  of 
Health  also  has  the  power  to  prohibit  new  works  of  this 
nature  wherever  the  stream  serves  as  a  source  of  water- 
supply  for  another  town  further  down  its  course.  The 
effect  of  discharging  sewage  into  streams  is  such  that  the 
streams  are  polluted  to  an  extent  sufficient  to  destroy  the 
fish  contained  in  it.  Such  water  is  always  injurious  to 
health  when  used  for  drinking-purposes.  The  Rivers' 
Pollution  Commission  of  England  reached  the  conclusion 
that  none  of  the  rivers  of  England  were  long  enough  to 
purify  themselves  by  the  natural  agencies  after  having 
been  polluted. 

Towns  along  the  seaboard  find  the  easiest  and  most 
economical  method  of  sewage  disposal  is  to  discharge  it 
into  the  sea.  There  are,  however,  objections  to  this 
method.  If  the  discharge  is  made  near  a  watering-place, 
it  will  injure  the  bathing.  The  sea-water  will  also  cause 
the  precipitation  of  certain  constituents  of  the  sewage,  and 
this  matter  will  cause  the  formation  of  a  barrier  or  reef 
along  the  shore,  unless  it  is  carried  out  into  deep  water. 

Chemical  Treatment  of  Sewage. — Where  there  is 
removal  by  water,  but  no  opportunity  for  disposal  into 
streams  or  other  bodies  of  water,  the  sewage  may 
be  subjected  to  one  of  several  processes  of  precipita- 
tion. The  sewage  is  sometimes  first  strained  to  re- 
move the  coarser  particles  by  passing  it  through  screens. 
The  materials  employed  in  precipitation  processes  are 
lime  and  ammonium  sulphate;  lime  and  iron  protosul- 
phate;  the  ABC  mixture,  consisting  of  alum,  blood,  and 
clay;  and  ferrozone  and  polarite.  The  precipitated 
matter,  or  sludge,  as  it  is  called,  is  used  for  fertilizing 


156  THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

purposes,  and  the  fluid  portion  is  discharged  into 
streams. 

Precipitation  works  are  in  use  in  the  following  cities 
of  England  :  Acton,  Ealing,  and  Sutton,  and  the  process 
is  still  partially  in  use  at  Manchester,  though  here  a 
portion  of  the  sewage  is  treated  by  several  of  the  modern 
methods  of  purification.  Precipitation  works  are  also 
in  use  at  Frankfort-on-the-Main,  at  Alliance,  O.,  and  at 
Worcester,  Mass.,  though  at  the  latter  place  a  portion  of 
the  sewage  is  purified  by  filtration. 

The  various  methods  of  chemical  treatment  of  sewage 
may  be  divided  into  the  following  groups  : 

1.  Intermittent  treatment  in  tanks  from  1.5  to  2.5 
meters  deep,  in  which,  after  the  addition  and  incorpora- 
tion of  the  chemicals,  the  sewage  is  allowed  to  remain 
until  the  completion  of  the  process. 

2.  Continuous  treatment  in  a  series  of  tanks  through 
which,  after  the  addition  and  incorporation  of  the  chem- 
icals, the  sewage  flows  slowly;  crude  sewage  and  chem- 
icals passing  in  at  one  end,  and  purified  effluent  passing 
out  at  the  other. 

3.  Vertical  tanks  through  which  the  sewage  rises 
slowly   after  the  addition  of  the  chemicals. 

There  are  a  number  of  variations  of  these  three  sys- 
tems, but  none  of  them  is  important  enough  to  justify 
further  subdivision  into  classes. 

The  conditions  necessary  for  success  from  chemical 
treatment  are  as  follows  : 

1.  The  sewage  should  be  treated  while  fresh. 

2.  The  chemicals  should  be  added  to  the  flowing 
sewage  and  thoroughly  mixed  with  it  before  it  passes 
into  the  settling  tanks. 

3.  There  should  be  a  liberal  amount  of  tank  space. 

4.  The  arrangements  for  the  removal  of  the  sludge 
should  be  such  as  to  insure  its  frequent  removal. 

The  sludge  obtained  by  the  treatment  of  sewage  is 
often  a  further  trouble,  because  it  has  to  be  finally' dis- 
posed   of.     It    may  be   burned,    or  it  may  be  used    for 


MODERN  ME  THODS  OF  SE  WA  GE  PURIFICA  TION.  157 

fertilizer  if  it  can  be  disposed  of  in  this  manner.  At 
Manchester,  England,  much  of  the  sludge  has  been  used 
in  filling  in  low  land  adjacent  to  the  precipitation  works. 

Modern  Methods  of  Sewage  Purification. —  The 
old  theory  that  filth  containing  pathogenic  organisms 
would,  when  exposed  to  the  sun,  propagate  various  dis- 
eases, has  been  entirely  overthrown.  Experimentally 
and  practically,  sewage  has  been  discharged  upon  land, 
which  may  or  may  not  have  been  prepared  to  receive  it, 
with  the  result  that  the  pathogenic  organisms  and  the 
offensive  nature  of  the  material  are  most  effectively 
destroyed. 

If  the  sewage  is  discharged  onto  a  piece  of  land  for 
the  purpose  of  enriching  the  soil  for  raising  crops,  it  is 
known  as  irrigation;  if  it  is  discharged  over  a  large  area, 
it  is  called  broad  irrigation ;  if  it  is  discharged  upon  land 
specially  prepared  to  receive  it,  with  no  idea  of  raising 
crops,  it  is  known  as  filtration. 

In  broad  migration  the  fields  should  be  divided  into 
sections  10  to  15  meters  square,  which  are  raised  in  the 
middle;  or  if  the  fields  are  uneven  in  contour,  they 
should  be  raised  into  ridges  of  corresponding  width. 
The  sewage  is  conveyed  to  the  middle  of  the  section  by 
means  of  an  open  drain.  At  certain  distances  dykes  are 
placed  in  a  drain,  which  cause  the  sewage  to  overflow  on 
the  slopes  of  the  section.  In  order  to  operate  satisfac- 
torily, and  carry  the  sewage  to  all  parts  of  the  field,  it  is 
discharged  upon  the  field  intermittently,  either  auto- 
matically by  means  of  a  Field  flushing  tank  (Fig.  42) 
or  by  opening  and  closing  sluices  whenever  a  discharge  is 
desired.  In  cold  latitudes  the  operation  of  the  irrigation 
field  is  inhibited  by  frost,  as  the  absorptive  power  of  the 
soil  is  feeble  at  low  temperatures.  From  a  sanitary 
standpoint  the  system  has  had  a  most  careful  investiga- 
tion, especially  in  England,  and  these  observations  have 
failed  to  show  the  origin  of  any  case  of  contagious  dis- 
ease from  it. 

Since  1870,  when  the  Rivers'  Pollution  Commission  of 


158  THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

England  proposed  in  their  report  the  purification  of 
sewage  by  irrigation  of  cultivated  land,  the  system  has 
been  introduced  into  over  145  English  towns.  Other 
European  towns  have  also  adopted  it,  including  Berlin, 
Breslau,  and  Dantzig.  In  America  it  has  been  introduced 
at  Wayne,  Pa.,  Pullman,  111.,  Greenfield,  Mass.,  and 
Berlin,  Out.  In  the  western  States,  where  there  is  a 
scarcity  of  water,  sewage  has  been  utilized  for  irrigation 
with  considerable  success.  In  California,  Fresno,  Pasa- 
dena, Redding,  Los  Angeles,  Santa  Rosa,  and  Stockton, 
all  irrigate  with  sewage.  In  Colorado,  Colorado  Springs 
and    Trinidad    utilize   sewage    for    irrigation    purposes. 


Fig.  42. — Field's  flushing  tank. 


Helena,  Mont.,  and  Cheyenne,  Wyo.,  also  utilize  sewage 
in  this  manner. 

In  order  to  operate  satisfactorily  the  system  requires  1 
acre  of  area  for  each  2000  persons  (2  square  meters  per 
person),  and  consequently  it  is  not  adapted  for  localities 
where  cheap  land  in  sufficient  quantities  and  of  suitable 
quality  cannot  be  obtained.  Large  towns  must,  there- 
fore, usually  avail  themselves  of  some  other  method  of 
sewage  purification. 

Purification  by  Means  of  Sand  Filters. — The  filtration 
of  sewage  by  means  of  specially  constructed  sand  filters, 
or  by  means  of  a  natural  sandy,  loamy  soil,  is  efficacious 


MODERN  ME  THODS  OF  SE  WA  GE  PURIFICA  TION.  159 

in  the  purification  of  sewage.  Because  of  the  absence  of 
free  oxygen  in  sewage  the  filtration  must  be  carried  on 
by  the  intermittent  method  in  order  to  give  the  nitrify- 
ing bacteria  an  opportunity  to  recuperate.  These  filters 
are  usually  operated  for  half  a  day  and  then  allowed  to 
rest  the  second  half  of  the  day.  This  necessitates  the 
construction  of  two  filters  that  can  be  operated  alter- 
nately. 

Experimentally,  much  work  has  been  done  at  the 
Lawrence,  Mass.,  Experiment  Station  upon  intermittent 
filtration,  by  passing  sewage  through  various  depths  of 
different  soils.  It  was  found,  among  other  results,  that 
some  forms  of  bacteria  would  pass  through  certain  filters 
more  readily  than  others;  that  in  certain  cases  where  the 
total  number  of  sewage  bacteria  had  increased  while 
the  sewage  was  passing  through  the  filter,  the  number 
of  species  of  bacteria  had  greatly  diminished. 

Intermittent  filtration  has  been  in  practical  operation 
for  some  time  at  Chichester  and  Sutton,  England,  and  at 
Gardner,  Marlborough,  Clinton,  South  Framingham, 
Medfield,  Worcester,  and  Brockton,  Mass.,  Summit, 
N.  J.,  East  Cleveland,  O. ,  Hastings,  Neb.,  Vassar 
College,  Poughkeepsie,  N.  Y.,  and  the  Iowa  State 
College,  at  Ames,  also  recently  adopted  this  system 
of  purification.  In  all  of  these  towns  the  system  em- 
ployed is  practically  a  combination  of  filtration  and 
irrigation.  The  effluent  water  from  this  combined  filtra- 
tion and  irrigation  method  in  no  way  indicates  its  origin 
by  temperature  or  smell,  although  it  tastes  quite  soft.  It 
may  easily  be  mistaken  for  spring-water,  as  it  comes  out 
of  the  pipe  clear  and  sparkling. 

At  Amherst,  Mass. ,  the  sewage  is  collected  in  a  stone 
tank  450x600  x  180  centimeters  in  size,  divided  into  two 
equal  compartments,  in  which  the  sewage  is  allowed  to 
settle.  This  arrangement  allows  one  compartment  to  be 
cleaned  of  its  sludge  while  the  other  is  receiving  the 
sewage.  The  sludge  is  removed  once  a  week.  The 
effluent   flows    through  a  pipe  to  the   river,   about    150 


160  THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

meters  distant.  No  further  purification  of  the  sewage  is 
attempted.  This  method  is  obviously  incomplete,  and 
should  be  used  only  as  a  preliminary  step  to  irrigation, 
filtration,  or  chemical  precipitation. 

The  following  table  shows  the  average  results  of  con- 
tinuous filtration  through  io|  feet  of  coarse  broken 
stone,  at  an  average  rate  of  1,897,000  gallons  per  acre 
daily  for  six  days  in  the  week,  from  May  to  November, 
inclusive  (parts  per  100,000): 

Filtration  through   Coarse  Broken   Stone. 

Sewage.  Effluent. 

Temperature,  degrees  Fahr 63  63 

Free  ammonia 3.47  0.7265 

Albuminoid  ammonia °-57  0.0963 

Chlorin 7.58  5.96 

Nitrogen  as  nitrates 1.88 

Nitrogen  as  nitrites 0.1247 

Oxygen  consumed 3-72  L09 

Bacteria  per  c.c 2,049,000  144,000 

Dissolved  oxygen,  percentage  of  satura- 
tion    38 

Subsurface  Irrigation, — Another  method  of  sewage 
disposal  which  is  available  for  small  towns  or  for  isolated 
dwellings  or  hotels  in  rural  districts,  is  what  is  known  as 
subsurface  irrigation.  In  this  system  pipes  with  open 
joints  are  distributed  underneath  the  garden  or  lawn 
through  which  the  sewage  flows  and  percolates  through 
the  open  joints  into  the  soil.  This  system  requires  the 
introduction  of  a  flushing  tank  in  order  to  carry  the 
sewage  to  all  parts  of  the  system.  The  household  drains 
empty  into  a  large  flushing  tank,  having  a  capacity  of 
about  15  cubic  meters,  separated  into  two  chambers  by  a 
wire-cloth  strainer  to  hold  back  obstructing  material.  A 
certain  amount  of  sludge  accumulates  in  the  bottom  of 
the  tank  and  has  to  be  removed  at  intervals.  This  sys- 
tem requires  about  40  square  meters  of  area  for  each  per- 
son (1  acre  per  100  persons). 

The  Cameron  Septic  Tank. —  Within  recent  years  the 
purification  of  sewage  on  a  large  scale  has  been  studied  ex- 


MODERN  ME  THODS  OF  SE  WA  GE  PURIFICA  TION.  1 6 1 

perimentally  and  practically  in  what  is  known  as  the  septic 
tank  or  bacterial  treatment  of  sewage  (Figs.  43,  44). 
This  is  a  complicated  system  which  utilizes  the  dissolving 
and  liquefying  action  of  anaerobic  species  of  bacteria  in 
one  portion,  the  so-called  septic  tank,  and  the  oxidizing 
action  of  aerobic  species  of  bacteria  in  another  portion, 
the  filter  beds,  several  of  which  are  arranged  in  series. 
Various  modifications  of  the  system  are  in  use  in  Eng- 
land and  America,  all  being  on  the  general  plans  pro- 
posed by  Cameron.     The  sewage  is  discharged  into  set- 


*3 


<& 


I    XL  MM 


XL  MM 


oeptie    IcLfcft-  "|;i 

O  Jnsheetum-      MM-  C 
K-y       'Well  V" 


Fig.  43. — Arrangement  of  septic  tank  and  series  of  filter  beds 


tling  basins,  from  which  it  is  transferred  to  the  septic 
tank.  In  some  of  the  works  the  septic  tank  is  made 
practically  air-tight,  so  as  to  facilitate  the  growth  of 
anaerobic  species.  In  others  it  is  simply  an  open  tank, 
the  idea  being  that  since  the  sewage  is  devoid  of  free 
oxygen,  therefore  the  conditions  are  favorable  to  the 
development  of  the  anaerobic  species,  because  the  sur- 
face scum  which  forms  renders  the  access  of  air  without 
effect.  Some  of  the  action  which  it  is  proposed  to 
obtain  in  the  septic  tank  has  already  taken  place  in  the 
sewage  during  its  course  to  the  disposal  works.  After  the 
solid  matters  in  the  sewage  have  undergone  solution  and 
11 


1 62    THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 


^ 


iiil'll'iMJi 


ili'lilli 


^]  B 


!!!i'l 


\¥ 


Mi 


iiiiiiiii 


liquefaction  in  the  septic  tank  the  sewage  is  discharged 
upon  the  first  series  of  four  or  five  niters,  on  which  a 
mixed  action  of  anaerobic  and  aerobic  bacteria  takes 
place,  bringing  about  the  breaking  down  of  the  inter- 
mediate dissolved  bodies.  These 
filters  are  operated  automatically, 
so  that  one  fills  after  the  other. 
When  the  last  filter  begins  to  fill, 
the  first  filter  discharges  its  con- 
tents. From  these  primary  filters 
the  sewage  is  discharged  on  to 
another  set  of  filters,  the  second- 
ary or  aerobic  filters,  where  the 
oxidation  process  is  completed. 
;  In  some  of  the  works  the  sewage 
I  is  discharged  on  to  the  secondary 
\  beds  by  means  of  a  revolving 
3      sprinkler.      Some    of  the   works 

1  are  without  the  secondary  filter 

L) 

°      beds.     The  filter  beds  are  com- 
a      posed  of  various  kinds  of  mate- 
j      rial,  as  clinkers  and  coke. 
\  The     bacterial    treatment    of 

$     sewage  by  means  of  the   septic 

2  tank  has  been  carefully  studied 
in   various    places    in    England. 
The  London  County  Council  has 
made   extensive   studies   on   the 
treatment    of    London    sewage. 
The     city    of     Manchester    has 
studied    the  problem  for  several 
years.     It  has  also  been  studied 
at    Exeter,     Oswestry,    Redhill, 
and    Sheffield,    and    at    Urbana, 
111.     This  system  has  been  intro- 
duced at  Independence,  Mo.,  during  the  past  year,  and 
has  been  thoroughly  studied  by  the  Massachusetts  State 
Board  of  Health. 


III! 


MODERN  ME  THODS  OF  SE  WA  GE  PURIFICA  TION.  163 

The  results  of  these  studies  have  been  quite  satisfac- 
tory, as  shown  in  the  following  report:1 

"From  the  results  obtained  in  England  and  at  the 
Lawrence  Experiment  Station  during  1898  and  1899,  it 
has  been  fully  demonstrated  that  the  addition  of  a  septic 
tank  to  a  sewage  purification  plant  may  be  of  great 
value  in  many  instances.  It  has  been  stated  many  times 
in  the  reports  of  this  Board  that  the  matter  in  suspension 
in  sewage  is  the  chief  factor  in  clogging  the  surfaces  of 
intermittent  sand  filters.  By  the  action  of  the  tank  a 
very  large  proportion  of  these  matters  in  suspension  is 
eliminated  from  the  sewage  when  it  flows  through  the 
tank.  A  certain  portion  changes  its  form  and  escapes, 
while  undoubtedly  at  times,  as  has  been  repeatedly 
noticed  at  Lawrence,  considerable  very  finely  divided 
solid  matter  comes  from  the  tank.  This  occurs  at  times 
when  the  movement  of  the  gas  in  the  tank  disturbs  the 
sludge,  and,  while  lasting  only  for  a  few  minutes  at  a 
time,  causes  considerable  solid  matter  to  flow  out  in  sus- 
pension. The  solid  matter  removed  in  this  way  is  of 
such  a  nature,  however,  that  it  is  rapidly  oxidized  when 
reaching  the  filter.  It  is  shown  by  the  results  obtained 
at  Lawrence  that  a  greater  percentage  of  change  occurs 
with  the  carbonaceous  matters  entering  the  tank  than 
with  the  nitrogenous  matters.  It  is  also  evident  from 
observation  that  the  clogging  of  the  surfaces  of  inter- 
mittent sand  filters  is  due  largely  to  carbonaceous  mat- 
ters— cellulose,  paper,  etc. — rather  than  to  nitrogenous 
matters.  For  example,  the  analysis  of  a  typical  sludge, 
which  had  covered  in  the  form  of  a  scum  the  surface  of 
one  of  the  beds  at  a  filtration  area  of  the  State,  showed 
that  only  2.5  per  cent,  of  it  was  organic  nitrogen,  while 
it  lost  53  per  cent,  on  ignition,  clue  to  the  large  amount 
of  carbonaceous  matter  present.  Careful  inspection  has 
shown  that  when  these  carbonaceous  matters  are  exposed 
in  comparatively  thin  layers  on  or  near  the  surfaces  of 
filters,  and  their  destruction  depends  entirely  on  oxida- 

1  Report  of  Massachusetts  State  Board  of  Health,  p.  424,  1899. 


1 64  THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

tion,  they  will  remain  for  a  very  long  period  without 
much  change.  In  the  septic  tank,  however,  where  the 
oxidizing  actions  are  eliminated,  and  only  the  putrefac- 
tive bacteria  live  and  work,  this  carbonaceous  matter  is 
more  quickly  attacked  by  them,  with  the  evolution  of 
carbonic  acid  gas  and  marsh  gas." 

The  results  obtained  by  the  London  County  Council  in 
its  studies  of  the  efficiency  of  the  bacterial  treatment  of 
sewage  show  that,  while  the  organic  matter  is  destroyed, 
the  pathogenic  bacteria  remain  in  the  sewage  in  very 
nearly  the  original  numbers  in  the  crude  sewage.  For 
instance,  there  is  practically  no  reduction  in  the  number 
of  colon  bacilli  present,  and  it  is,  therefore,  fair  to  assume 
that  there  is  no  reduction  in  the  number  of  typhoid 
bacilli.  This  fact  indicates  that  the  effluent  from  the 
coke  beds  is  by  no  means  free  from  danger  when  dis- 
charged into  running  streams.  In  order  to  overcome  this 
objection  the  suggestion  has  been  made  that  the  effluent 
be  further  treated  by  passing  it  through  a  sand  filter.  It 
appears  to  be  in  good  condition  to  be  efficiently  purified 
by  sand  filtration.  The  chemical,  purification  of  sewage 
at  Oswestry,  by  this  system,  shows  a  reduction  of  90.2 
per  cent,  of  the  albuminoid  ammonia,  and  of  89.8  per 
cent,   of  the  oxygen  consumed. 

The  Bacteria  or  Contact=bed  System. — In  this  system 
the  sewage  is  treated  in  an  open  tank  containing  a  bed 
of  coke,  clinker,  or  clay  to  a  depth  of  1  to  2  meters.  On 
the  floor  of  the  tank  are  open-jointed  collecting  pipes. 
These  contact  beds  are  usually  operated  in  pairs,  the  first 
or  primary  bed  acting  on  the  sewage  for  several  hours 
and  then  discharging  its  contents  on  to  the  second  bed  by 
gravity,  where  the  sewage  is  treated  for  the  same  length 
of  time.  This  system  was  devised  by  W.  J.  Dibdin, 
formerly  Chief  Chemist  to  the  London  County  Council. 
The  action  of  these  contact  beds  is  intermittent,  but 
differs  from  intermittent  downward  filtration  in  that  the 
sewage  is  held  in  contact  with  the  bed  material  for  some 
time.     The  coarseness    of  the  material    composing   the 


MODERN  ME  THODS  OF  SE  WA  GE  PURIFICA  TION.  165 

beds  makes   it  necessary  to  hold  the  sewage  in  contact 
with  it  to  allow  time  for  the  nitrification  to  take  place. 

This  system  has  been  studied  at  Manchester  and  at 
several  points  in  London  during  the  past  five  or  six  years. 
The  amount  of  purification  brought  about  by  this  sys- 
tem, as  shown  by  the  Manchester  experiments,  is  a 
reduction  of  the  oxygen  consumed  from  77.4  to  83.4  per 
cent,  and  of  albuminoid  ammonia  from  67.8  to  76.1  per 
cent.  The  contact  beds  received  three  and  four  fillings 
a  day  in  the  Manchester  experiments,  and  the  efficiency 
seemed  greatest  with  four  fillings  a  day. 

The  Garfield  Coal  Filters. — The  first  experiments  with 
coal  as  the  filtering  material  were  made  by  Mr.  Joseph 
Garfield  at  Wolverhampton,  England,  in  1896.  Several 
experimental  coal  filters  have  since  been  constructed  in 
other  places,  notably  at  Litchfield.  The  efficiency  of 
these  filters  is  indicated  by  a  reduction  of  the  oxygen 
consumed  of  78  per  cent.,  and  of  albuminoid  ammonia 
of  71.2  per  cent.  The  filtration  is  intermittent  with  a 
run  of  twelve  hours  and  a  rest  of  the  same  length  of 
time. 

The  depth  of  the  filtering  material  should  not  be  less 
than  11/,  meters.  The  first  layer  of  the  filter  consists  of 
i}4  decimeters  of  coal  about  a  centimeter  in  size.  This 
layer  is  blinded  with  a  little  of  y2  centimeter  cube  coal. 
Above  this  comes  a  layer  of  about  jl/2  decimeters  of 
cubes  3  millimeters  in  size  and  on  top  another  layer  of 
about  jy2  decimeters  of  cubes  1%  millimeters  in  size. 
The  top  course  is  a  1^  decimeter  layer  of  coal  dust 
which  has  passed  through  a  i}4  millimeter  mesh.  The 
rate  of  filtration  has  been  1100  cubic  meters  per  hectare 
per  day  (1,000,000  gallons),  and  it  is  believed  that  the 
rate  may  be  increased  without  materially  lessening  the 
efficiency. 

These  bacterial  systems  of  sewage  purification  are  im- 
portant advances  in  the  purification  of  sewage,  though 
the  fact  that  the  pathogenic  organisms  appear  to  be  unin- 
fluenced, and  the  further  fact  that  there  remains  from  15 


1 66   THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

to  20  per  cent,  of  the  organic  matter  unreduced,  leave 
these  systems  open  to  objection.  The  effluent  is  not 
safely  disposed  of  in  running  streams  that  serve  as  water- 
supplies  without  further  chemical  treatment  or  further 
purification  by  passing  it  through  sand  filters. 

The  Committee  of  the  American  Public  Health  Asso- 
ciation makes  the  following 

"  Summary  Concerning  Sewage  Purification  Plants 
now  in  Operation  in  America.1 — It  appears  that  there 
are  now  in  operation  in  America  several  hundred  sewage 
purification  plants,  ranging  in  size  from  those  for  cities 
of  more  than  100,000  inhabitants  down  to  those  for 
small  institutions  and  summer  hotels.  With  regard  to 
the  larger  ones,  the  available  information  indicates  that 
there  are  about  seventy-five  which  treat  the  sewage  of 
about  500  persons  or  more.  Many  of  these  plants  were 
installed  to  reduce  the  pollution  of  public  water-supplies, 
while  a  large  number  are  operated  with  a  view  to  obvi- 
ating nuisances,  such  as  would  arise  from  putrefactive 
chanees  in  the  bodies  of  water  into  which  the  effluents 
are  discharged. 

"  More  or  less  information  of  a  general  nature  concern- 
ing many  of  these  plants  is  available  through  official 
reports  and  articles  in  professional  and  technical  journals. 
Detailed  specific  information  upon  various  points  of 
importance,  however,  is  for  the  most  part  confined  to 
the  larger  plants  in  Massachusetts,  which  have  been 
examined  by  the  Board  of  Health  of  that  State.  Com- 
pilations of  the  leading  published  information  available 
from  the  larger  plants  have  been  made  by  your  chairman, 
supplemented  somewhat  by  personal  inspection  and  by 
correspondence.  While  as  yet  the  amount  of  directly 
comparable  data  is  too  meager  to  warrant  a  detailed  pres- 
entation, yet  these  comparisons  bring  clearly  to  light  a 
number  of  points  of  general  interest  and  of  suggestive 
value. 

"  The  point  upon  which  our  knowledge  has  been  most 

1  Engineering  Record,  November,  1900. 


PURIFICA  TION  PLANTS  IN  AMERICA. 


167 


advanced  through  data  coming  from  sewage  purification 
plants  in  actual  practice  seems  to  be  the  composition  of 
sewage.  For  years  it  has  been  known  that  the  composi- 
tion of  all  sewages  varies  widely  at  different  times,  and 
that  American  sewages  are  much  more  dilute  than  those 
abroad.  It  is  the  amount  of  suspended  organic  and  min- 
eral matters  in  a  sewage  which  usually  gives  the  best 
index  to  its  composition  with  reference  to  purification. 
The  reasons  for  this  are  that  suspended  mineral  matter 
becomes  a  sludge,  which,  after  greater  or  less  accumula- 
tion, requires  removal  by  physical  means  at  considerable 
expense;  while  the  suspended  organic  matter  is  the  chief 
factor  of  difficulty  in  processes  for  thorough  purification, 
from  the  standpoint  of  both  cost  and  efficiency.  There 
are  at  least  twelve  places  in  this  country  where  such 
information  has  been  obtained  with  sufficient  frequency 
to  yield  results  which  may  be  used  as  approximate  aver- 
ages. As  a  matter  of  reference,  these  results,  taken  from 
the  reports  of  the  State  Boards  of  Health  of  Massachusetts 
and  Connecticut,  are  given  in  the  following  table,  beyond 
which  are  corresponding  results  from  European  sewages: 


Record  of  Average  Suspended  Matters  in  some  American 
Sewages  {Parts  per  Million). 


Place. 

Brockton,  Mass 

Chicago  Exposition     .    .    .    . 

Framingham,  Mass 

Gardner,  Mass 

Lawrence,  Mass 

Leicester,  Mass 

Marlboro,  Mass 

Medfield,  Mass 

Meriden,  Conn 

Natick,  Mass 

Spencer,  Mass 

Worcester,  Mass 

Total  average 

Total  except  Framingham  . 


893 

893-98 

893-98 

888-89 

897-98 

892-98 

894-98 

897-98 

897-98 

898 

893-94 


Total. 
I20 
182 

I364 
134 
240 
106 
20I 
I07 
I20 
23 

95 
212 

140 
140 


Mineral. 

23 

29 

154 

31 

102 

25 

53 
26 

38 
12 

13 
99 
50 
4i 


Organic. 
Parts.     Per  cent. 

97    81 


153 
1210 

103 

138 
81 

148 
81 
82 
1 1 
82 

"3 

192 
99 


84 
89 
77 
57 
77 
74 
76 
68 
45 
87 
53 
79 
7i 


168  THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

Record  of  Average  Suspended  Matters  in  some  European 
Sewages  {Parts per  Million). 

Organic. 


Place.                                  Authority.  Total.  Mineral.     Parts.     Per  cent. 

Average  of  16  Eng-  r          Riyer  pollution  } 

lish    water-closets                   c  >     447       242        205           46 

towns.                       v.  J 

London,  1S94     .    .    .  Dibden 450 

Sutton,  1S99        .    .    .  Rideal 609 

Leeds City  Document     .    .    .  531 

Accrington,  1899    .    .  Naylor 305        203        300           59 

Danzig Koenig 582       226        356           60 

Berlin Koenig 1085       383        782           65 

Breslau Koenig 405       205        200           49 

Halle Koenig 594        189        405            68 

Frankfort Koenig II93       387        866           67 

Leicester,  1898-99    .  City  Document     .    .    .  624 

Salford,  1S92     .    .    .  Vogel 512        144        368            72 

Cassel Hoepnerand  Paulmann  5460     1246      4214            78 

"With  regard  to  the  fundamental  principles  which 
control  the  operation  of  plants  in  practice  for  the  purifica- 
tion of  sewage  by  irrigation  or  intermittent  filtration, 
the  most  comprehensive  statement  which  can  now  be 
made  is  to  the  effect  that  the  available  evidence,  so  far  as 
it  goes,  testifies  to  the  soundness  of  the  laws  which  were 
formulated  at  the  Lawrence  Experiment  Station.  In 
fact,  there  are  some  indications  that  somewhat  better 
results  may  be  expected  in  practice  than  have  been  ob- 
tained from  the  experimental  filters,  other  things  being 
equal. 

"  For  a  high  degree  of  purification  of  sewage  entering 
small,  short  feeders  to  public  water-supplies,  there  is  no 
evidence  to  indicate  that  this  can  be  accomplished  in  a  bet- 
ter manner  than  by  intermittent  filtration.  The  cost  of  this 
treatment  depends  largely  upon  local  conditions.  Where 
ample  areas  of  suitable  land  are  readily  available  at  a 
low  cost,  as  in  the  case  of  many  places  in  New  England, 
first-class  results  can  be  obtained  at  the  least  cost  by  this 
method  in  its  simplest  form;  but  where  suitable  land  is 
very  scarce  and  expensive,  or  where  filters  would  have  to 
be  built  of  selected  material  brought  from  a  distance,  the 


PURIFICA  TION  PLANTS  IN  AMERICA.  169 

indications  are  that  economy  demands  that  the  sewage 
receive  a  preliminary  treatment,  so  as  to  allow  of  higher 
rates  of  filtration.  Such  a  preliminary  treatment  relates, 
of  course,  to  clarification  of  the  crude  sewage,  or,  in  other 
words,  to  the  removal  of  the  suspended  matters  which 
exert  such  a  troublesome  clogging  at  the  surface  of  the 
filters. 

"Much  study  for  many  years  has  been  given  to  the 
clarification  of  sewage  as  a  preliminary  step  in  its  puri- 
fication, and  the  problem  is  still  an  open  question. 
During  the  past  few  years  the  so-called  septic  tank  sys- 
tem has  been  much  talked  about  in  this  connection. 
Although  this  procedure  is  being  tried  on  a  greater  or 
less  scale  at  ten  or  twelve  different  places  in  this  country, 
comparatively  little  is  now  known  in  definite  terms  con- 
cerning its  practicability  under  various  known  conditions 
as  to  the  sewage  treated  and  details  of  devices  employed. 
Opinion  as  to  its  merits  is  widely  at  variance.  Some 
very  erroneously  appear  to  regard  it  as  a  complete  purifi- 
cation process  by  itself,  and  a  successful  solution  of  the 
difficulty  of  final  disposition  of  matters  suspended  in 
sewage.  Others  seem  to  question  its  practicability  on 
the  basis  that  there  will  be  a  large  accumulation  of 
sludge  in  the  septic  tank,  involving  much  expense  for  its 
removal  as  well  as  nuisances  due  to  bad  odors.  What- 
ever the  future  may  show  to  be  the  true  merits  of  the 
septic  tank,  it  is  certain  that  it  can  never  afford  a  final 
disposition  for  the  suspended  mineral  matter  in  the  sew- 
age. This  is  a  point  of  much  significance,  as  the  mineral 
matters  form  from  20  to  40,  and  sometimes  50  per  cent. 
•of  the  solids  in  suspension. 

"With  regard  to  filtration  of  sewage  at  comparatively 
high  rates,  to  secure  moderate  purification  for  cases  in 
which  the  effluents  are  very  indirectly  or  not  at  all  con- 
nected with  public  water-supplies,  there  is  very  little  evi- 
dence from  actual  operations  in  this  country.  In  general 
terms  it  would  appear  that  success  in  this  important'field 
will  be  associated  to  a  considerable  deeree  with  the  free- 


170   THE  REMOVAL  AND  DISPOSAL  OF  SEWAGE. 

dom  from  suspended  matters  in  the  sewage  as  it  reaches 
such  filters.  It  is  felt  that  much  more  information  is 
needed  in  this  branch  of  the  work  before  large  plants  can 
be  built  with  confidence  as  to  permanency  and  economy." 
Removal  of  Sewage  by  Iyierntir  System. — The 
satisfactory  disposal  of  sewage  is  influenced  directly 
by  the  fact  whether  the  removal  is  by  the  separate  or 
combined  system.  In  the  separate  system  of  removal 
two  sets  of  pipes  are  provided,  one  set  for  the  house- 
hold sewage,  and  another  for  the  storm-water.  This  sim- 
plifies the  purification  process  to  a  considerable  extent. 
When  the  separate  system  of  removal  is  employed  some 
provision  must  be  made  for  either  flushing  out  the  pipes 
carrying  the  household  sewage,  such  as  a  flushing  tank 
at  the  head  of  each  branch  sewer,  or  one  of  the  methods 
of  "air  removal"  may  be  employed.  The  method  of 
air  removal  in  more  common  use  is  what  is  known  as  the 
Liernur  system.  In  this  system  there  are  two  sets  of 
pipes,  the  one  set  containing  air  only,  and  by  the  produc- 
tion of  a  partial  vacuum  in  this  set  of  pipes  the  sewage  is 
extracted  from  the  drain  pipes.  The  system  is  so  arranged 
that  the  discharges  from  each  house  are  delivered  into  an 
air-tight  metal  reservoir,  from  which  they  are  in  turn 
drawn  by  suction  into  larger  collecting  tanks,  these  lat- 
ter delivering  the  matter  into  a  stream  or  into  the  dis- 
posal works.  The  main  collecting  tanks,  receiving  the 
sewage  from  the  different  branches,  are  at  the  lowest 
point  of  the  district  drained.  A  powerful  suction  pump 
produces  a  vacuum  in  the  system,  and  once  a  day  the 
entire  system  is  exhausted.  Each  branch  drain  and 
reservoir  is  extracted  in  turn  by  closing  off  the  rest  of  the 
system  by  means  of  valves;  and  finally  the  main  collect- 
ing tanks  are  extracted.  The  entire  operation  is  the 
work  of  one  man,  who  makes  the  tour  of  the  system,  his 
only  labor  being  the  opening  and  closing  of  valves. 
There  is  nothing  to  give  offence  to  the  senses  in  this  sys- 
tem, as  all  the  tanks  are  underground  and  the  valves  are 
operated  from  connections  at  the  surface  of  the  ground. 


COMMERCIAL    VALUE  OF  SEWAGE.  iyi 

Owing  to  the  manner  in  which  the  material  is  collected, 
its  conversion  into  fertilizer  is  commercially  possible,  so 
as  to  yield  a  considerable  revenue.  At  Trouville, 
France,  where  the  population  during  the  season  reaches 
20,000,  it  is  estimated  that  the  receipts  from  the  sale  of 
the  poudrette  will  furnish  a  material  income  over  and 
above  the  operating  expenses.  This  system  of  air  ex- 
traction is  especially  adapted  for  places  in  which  the 
sewers  lie  too  low  to  discharge  directly  into  streams. 

The  Liernur  system  of  extraction  has  been  in  opera- 
tion for  more  than  twenty-five  years  in  Amsterdam  and 
Leyden,  and  its  success  in  these  older  installations  has 
led  to  its  introduction  into  other  cities.  The  latest  appli- 
cation of  the  method  has  recently  been  completed  at  the 
watering-place  Trouville,  France. 

Commercial  Value  of  Sewage. —  Many  scientists 
have  attempted,  by  chemical  analysis,  to  demonstrate 
the  commercial  value  of  the  constituents  of  sewage  as 
fertilizer.  One  investigator  has  estimated  the  yearly 
solid  and  liquid  excreta  of  an  adult  person  to  yield  7.44 
kilograms,  an  amount  sufficient  to  fertilize  about  365 
kilograms  of  wheat,  rye,  or  oats,  or  about  410  kilograms 
of  barley ;  equivalent  to  34  kilograms  of  Peruvian 
guana.  Several  scientists  have  estimated  the  manurial 
value  of  London  sewage  to  range  from  3^  to  5  cents  per 
ton,  having  an  annual  value  of  14,000,000  to  20,000,000 
dollars.  It  does  not  matter,  however,  what  the  intrinsic 
value  may  be  of  the  manurial  constituents  of  sewage,  the 
nitrogen,  phosphoric  acid,  and  potash  salts,  so  long  as 
the  conditions  affecting  supply  and  demand  can  neither 
be  controlled  nor  regulated,  its  commercial  value  must 
remain  very  small — indeed,  so  small  that  sewage  is  much 
more  likely  to  become  a  source  of  expense  than  one  of 
revenue  to  any  community.  This  has  been  the  expe- 
rience almost  everywhere  where  attempts  have  been 
made  to  utilize  sewage  as  fertilizer.  The  compressed 
sludge,  the  product  of  precipitation  works,  accumulates 
far  more  rapidly  than  it  can  be  disposed  of  as  fertilizer, 


1/2    THE  REMOVAL  AND  DISPOSAL  OE  SEWAGE. 

and  it  frequently  becomes  a  troublesome  matter  to  dis- 
pose of  it  economically  and  satisfactorily.  Even  in  such 
instances  where  sewage  is  utilized  to  irrigate  cultivated 
fields  it  has  at  times  been  found  detrimental  to  the  crops 
raised,  principally  on  account  of  the  excessive  quantities 
applied  keeping  the  land  constantly  in  a  water-loo-o-ed 
condition.  This  is  said  to  have  been  the  experienced 
Pullman,  111. 


CHAPTER    VI. 
GARBAGE  DISPOSAL. 

The  whole  subject  of  the  disposal  of  garbage  and  other 
household  waste  must  be  considered  from  an  economic  as 
well  as  from  a  sanitary  standpoint,  if  satisfactory  results 
are  to  be  obtained.  The  question  of  utilization  has  here- 
tofore been  one  of  secondary  consideration.  If  the  cost 
of  disposal  can  be  reduced  by  utilizing  a  part  or  the  whole 
of  the  refuse,  then,  for  financial  reasons,  such  utilization 
should  be  advocated. 

The  sanitary  question  seems  to  narrow  itself  down 
mainly  to  the  prevention  of  all  nuisance,  no  evidence 
having  been  obtained  to  indicate  a  serious  effect  upon  the 
health  of  those  engaged  in  the  disposal  of  this  refuse  or 
in  picking  it  over  before  final  disposal. 

In  the  southern  States  the  term  "garbage"  is  some- 
times applied  to  dry  refuse  (Atlanta,  Ga.),  and  to  a 
mixture  of  dry  refuse  with  animal  and  vegetable  waste. 
In  New  England  the  word  "  swill  "  is  more  commonly 
used  to  designate  kitchen  waste,  etc.,  while  in  Pennsyl- 
vania and  one  or  two  other  States  "slop"  is  the  name 
applied  to  this  material.  The  garbage  is  usually  collected 
two  or  three  times  a  week,  but  somewhat  more  fre- 
quently in  densely  populated  districts,  and  during  the  hot 
weather  daily  collections  should  be  made  in  cities. 
Ashes  and  dry  refuse  are  usually  collected  once  a  week 
throughout  the  year.  The  collection  is  made  either  by 
private  service,  by  contract,  or  by  department  employes. 

The  best  information  obtainable  from  analyses  of  gar- 
bage made  in  Europe  shows  the  presence  of  60  to  80  per 
cent,  of  moisture;  rubbish,  such  as  bottles,  cans,  rags,  etc., 
about  7  per  cent. ;  animal  and  vegetable  dry  matter,  about 
20  per  cent. ;  and  grease,  from  2  to  4  per  cent.     The  ashes 

173 


174  GARBAGE  DISPOSAL. 

from  the  cremation  of  garbage  constitute  about  5  per  cent, 
of  the  original  mass.  Mr.  Westinghouse,  of  New  York, 
estimates  that  garbage  is  composed  of  about  20  per  cent, 
of  carbon  and  80  per  cent,  of  water. 

Collection  and  Removal  of  Garbage. — Where  the 
garbage  is  removed  either  by  the  municipal  authorities 
directly  or  by  contractors,  it  should  be  collected  in  water- 
tight receptacles  supplied  with  lids,  so  as  to  prevent  pol- 
lution of  the  air  and  soil  at  the  point  of  collection.  These 
receptacles  should  be  emptied  daily  during  the  summer 
months,  and  every  other  day  during  the  remainder  of  the 
year. 

The  carts  or  wagons  employed  in  removing  garbage 
should  be  constructed  of  metal,  and  so  designed  as  to  suit 
the  special  conditions.  These  carts  should  be  supplied 
with  lids,  so  that  none  of  the  material  may  be  lost  during 
removal,  and  also  to  limit  the  escape  of  objectionable 
odors  during  transit. 

The  following  form  of  ordinance,  recently  transmitted 
to  councils  by  the  mayor  of  Philadelphia,  is  intended  to 
reform  the  mode  of  handling  garbage,  the  reforms  being 
based  upon  the  regulations  in  force  in  New  York  and 
Boston: 

"Section  1.  That  it  shall  be  unlawful  for  any  person 
or  persons  to  keep  in  his  house  or  on  his  land  any  kitchen 
garbage  or  offal,  unless  the  same  is  placed  in  water-tight 
vessels,  free  from  ashes  and  other  refuse  matter  (except 
food  cans  and  food  bottles). 

"Section  2.  No  person  shall  place  or  keep  in  or  near 
any  building,  ashes  or  cinders  in  such  a  manner  as  to 
cause  fire,  nor  mix  them  with  other  substances,  nor  place 
or  keep  them  except  in  metallic  vessels  so  placed  as  to  be 
easily  removed. 

"  Section  3.  All  other  refuse,  such  as  paper,  rags,  ex- 
celsior, straw  mattress,  old  clothing,  pasteboard  boxes, 
carpet,  and  other  household  waste,  shall  be  kept  in  suit- 
able vessels  free  from  ashes  and  garbage,  or  in  bundles, 
firmly  fastened  so  as  to  prevent  the  rubbish  from  being 


COLLECTION  AND  REMOVAL  OF  GARBAGE.   175 

scattered  in  the  handling,  and  protected  from  the  weather 
until  collected  by  the  proper  authority. 

"Section  4.  Ashes  placed  out  for  removal  shall  be 
moistened  sufficiently  to  keep  down  dust  while  handling, 
and  placed  within  4  feet  of  the  building-line,  in  vessels 
that  will  hold  their  contents  without  spilling;  shall  be 
placed  out  only  on  the  day  set  for  such  removal,  and 
taken  in  when  emptied  of  their  contents." 

Disposal  of  Garbage.— There  are  a  number  of  meth- 
ods of  disposal  in  use.  This  is  partly  due  to  the  varying 
character  of  the  refuse  in  different  cities,  as  regards 
moisture,  ashes,  unburnt  coal,  and  animal  and  vege- 
table matter,  and  partly  to  special  circumstances  which 
favor  one  or  the  other  method.  The  system  of  dispos- 
ing of  garbage  by  reduction  is  used  in  about  twelve 
cities  in  the  United  States.  Cremation  systems,  by 
which  garbage  is  destroyed  by  fire,  are  in  use  in  a 
large  number  of  cities.  Eight  cities  dispose  of  their 
garbage  by  dumping  it  on  land.  This  form  of  dis- 
posal costs  from  11  to  39  cents  per  capita  per  year. 
In  those  cities  which  dump  their  garbage  into  the 
sea  or  into  rivers  the  cost  is  from  36  to  75  cents  per 
capita.  In  cities  where  the  garbage  is  fed  to  animals  the 
cost  of  collection  and  disposal  varies  from  28  to  37  cents 
per  capita,  and  this  probably  takes  into  account  the  reve- 
nue which  the  contractor  derives  from  the  sale  of  this 
material.  In  smaller  cities  the  cost  of  disposal  by  feeding 
to  animals  is  sometimes  as  low  as  9  cents  per  capita. 
The  cost  of  disposal  by  reduction  processes  varies  from  15 
to  6y  cents  per  capita.  The  cost  of  disposal  by  cremation 
is  found  to  vary  from  6  to  10  cents  per  capita  in  medium- 
sized  cities,  and  in  one  small  city  a  cost  of  20  cents  per 
capita  is  given. 

Several  years  ago,  New  York  City  made  a  contract 
with  the  New  York  Sanitary  Utilization  Company  for 
the  disposal  of  garbage,  the  price  being  about  $90,000 
per  annum.  It  contemplates  the  treating  of  the  garbage 
of  the  entire  city  by  steam,  sterilizing  it,  and  then,  by 


176  GARBAGE  DISPOSAL. 

great  pressure,  separating  the  water  and  grease  from  the 
residue  (called  "tankage"),  which  is  salable  as  fertilizer. 
Recently,  Mr.  Westinghouse  made  the  suggestion  that 
the  garbage  of  New  York  be  utilized  in  the  manu- 
facture of  gas  to  be  used  for  fuel  purposes.  He  esti- 
mates that  New  York  produces  about  509,000  kilograms 
of  garbage  annually.  Dr.  Hutchinson  estimates  that 
450  grams  of  this  refuse  have  a  maximum  theoretical 
heating  value  of  approximately  2000  calories,  and  that 
if  all  of  this  energy  could  be  recovered  in  the  form  of 
gas  it  would  require  3.85  kilograms  of  refuse  per  unit 
(kilowatt-hour)  of  electrical  energy,  and  that  "a  consid- 
eration of  the  elementary  principles  involved  shows  a 
probable  relation  of  6.8  kilograms  of  refuse  per  unit 
(kilowatt-hour)  in  comparison  with  11. 3  kilograms, 
deduced  from  extensive  tests  with  steam."  These  sug- 
gestions are  of  the  greatest  financial  as  well  as  sanitarv 
importance,  and  seem  to  offer  something  which  will 
not  only  favor  the  more  systematic  collection  of  gar- 
bage, but  also  its  disposal  to  the  financial  advantage  of 
the  community. 

Where  the  municipal  authorities  fail  to  provide  the 
necessary  system  for  the  removal  and  disposal  of  garbage 
the  novel  method  of  disposing  house  refuse,  introduced 
several  years  ago,  may  be  adopted  by  the  individual 
householder.  This  is  domestic  disposal  in  a  special 
apparatus  attached  to  the  kitchen  range.  It  consists  of 
a  perforated  sheet-iron  basket,  with  a  tight  bottom  and 
a  capacity  of  2000  to  3000  cubic  centimeters.  It  is 
inserted  into  an  expanded  section  of  the  stove  pipe,  a 
short  distance  above  the  kitchen  range,  and  allows  the 
hot  air  and  smoke  to  pass  on  all  sides  of  the  basket.  It 
is  easily  withdrawn  from  its  position  and  replaced  with 
one  hand.  The  garbage  is  placed  into  the  basket  as  fast 
as  it  accumulates,  and  the  contents  are  removed  once  a 
day.  It  dries  to  charcoal  without  burning,  and  becomes 
an  excellent  fuel  for  kindling  the  fire  in  the  morning. 
It  does  not  impair  the  use  of  the  stove,  nor  interfere  with. 


COLLECTION  AND  REMOVAL  OF  GARBAGE.  177 

the  draught,  causes  no  odors,  and  does  not  require  any- 
extra  fuel. 

For  hotels,  hospitals,  or  other  public  institutions  some- 
thing of  greater  capacity  must  be  provided  for  the  dis- 
posal of  the  garbage.  To  meet  this  demand  a  portable 
furnace  has  been  devised,  occupying  about  one-third  of  a 
square  meter  of  space,  with  an  independent  chimney 
connection,  which  will  destroy  the  waste  in  quantities  of 
nearly  a  barrel  at  once.  This  apparatus  has  a  garbage 
receptacle  or  retort  of  cast  iron,  cylindrical  in  form,  with 
a  cast-iron  grate  at  the  bottom.  This  retort  is  suspended 
30  to  40  centimeters  above  the  fire  pot  in  the  furnace, 
and  the  whole  is  encased  in  a  jacket  of  heavy  sheet  iron. 
In  operating,  the  retort  is  filled  with  garbage  introduced 
through  the  charging  door,  a  moderate  fire  is  started,  and 
the  process  of  cremation  begins.  ■  A  simple  arrangement 
of  air  jets,  automatically  actuated  by  the  natural  draught 
of  the  chimney,  exhausts  all  the  smoke  and  odors  of  the 
burning  garbage  from  the  retort  and  carries  them  down 
and  through  the  furnace  fire,  so  that  nothing  but  the 
thoroughly  purified  and  odorless  gases,  liberated  by 
combustion,  can  escape  into  the  chimney  flue.  Such  an 
apparatus  requires  a  comparatively  small  amount  of  fuel. 
12 


CHAPTER  VII. 
FOOD   AND   DIETING. 

Not  only  the  health  and  strength  of  the  body,  but  the 
intellectual  and  moral  character  as  well,  are  dependent 
upon  the  nature  and  quantity  of  the  food-supply.  For 
this  reason  the  question  of  food  and  diet  is  most  complex, 
and  the  sanitary  phase  of  it  is  not  the  most  important 
one.  It  is,  however,  of  sufficient  importance  to  demand 
consideration  in  connection  with  general  hygienic  condi- 
tions, because  of  its  relation  to  the  welfare  of  man  in 
general,  and  because  of  the  dangers  that  arise  from 
improper  food  materials,  and  also  because  of  the  influence 
upon  health  of  excessive,  as  well  as  deficient,  amounts 
of  food. 

Dr.  Atwater  defines  food  as  follows:  "Food  is  that 
which,  when  taken  into  the  body,  builds  up  its  tissues 
and  keeps  them  in  repair,  or  which  is  consumed  in  the 
body  to  yield  energy  in  the  form  of  heat  to  keep  it  warm 
and  create  strength  for  its  work." 

Chemical  Composition  of  the  Body. — In  order  to 
understand  the  needs  of  the  body  in  the  shape  of  food  to 
maintain  its  form  and  character,  it  will  be  necessary  to 
consider  briefly  its  chemical  constituents.  These  are 
both  organic  and  inorganic  in  their  nature,  composed  of 
the  following  elements  combined  into  a  number  of  com- 
pounds :  Hydrogen,  oxygen,  nitrogen,  carbon,  chlorin, 
fluorin,  sulphur,  silicon,  phosphorus,  potassium,  sodium, 
lithium,  calcium,  magnesium,  and  iron. 

The  inorganic  constituents  of  the  body  are  water, 
which  comprises  about  two-thirds  of  its  weight;  different 
gases,  such  as  oxygen,  hydrogen,  nitrogen,  carbon 
dioxid,    ammonia,    hydrogen   sulphid,    and   marsh   gas; 

178 


CHEMICAL  COMPOSITION  OF  THE  BODY.       179 

salts,  such  as  sodium  chlorid,  calcium  phosphate  (which 
forms  more  than  one-half  the  substance  of  the  bones), 
calcium  carbonate  and  fluorid,  sodium  and  potassium 
sulphate,  potassium  and  ammonium  chlorid,  sodium, 
potassium,  and  magnesium  phosphate,  and  sodium  car- 
bonate and  bicarbonate;  hydrochloric  acid;  silica;  and 
iron. 

The  organic  constituents  may  be  divided  into  the 
nitrogenous  and  non-nitrogenous  bodies,  of  which  the 
nitrogenous  are  the  most  numerous.  They  consist  of 
the  albuminous  bodies,  or  proteids;  the  albuminoid  sub- 
stances; certain  complex  bodies,  such  as  the  ferments, 
coloring-matters,  and  glucosids;  and  the  ammonia  deriv- 
atives. The  non-nitrogenous  bodies  consist  of  two 
groups,   fats  and  carbohydrates. 

All  of  these  various  elements  and  chemical  combina- 
tions, constituting  the  composition  of  the  body,  must  be 
supplied  in  the  food-supply  in  order  that  it  may  perform 
its  normal  functions  and  obtain  energy  for  all  of  man's 
activities  in  life.  Under  normal  physiologic  conditions 
the  amount  of  material  absorbed  from  the  food  is  about 
equal  to  that  which  is  thrown  off  by  the  excretory 
organs.  During  the  period  of  growth  the  amount 
absorbed  exceeds  the  amount  excreted,  while  in  most 
acute  diseases  the  amount  excreted  is  far  in  excess  of  the 
amount  absorbed,  and,  consequently,  the  body  wastes. 
The  body  increases  or  diminishes  in  weight  proportion- 
ately as  the  amount  of  material  absorbed  from  the  food 
is  greater  or  less  than  the  amount  excreted.  A  man  of 
average  weight  and  activity  takes  about  325  grams 
of  dry  solid  matter  and  from  1500  to  2000  grams  of 
water,  while  about  550  grams  of  oxygen  are  absorbed 
by  the  lungs  per  day.  Of  the  solids  taken,  about  40 
grams  are  eliminated  by  the  intestines,  and  the  remaining 
285  grams  by  the  other  excretory  organs.  The  oxygen 
taken  in  is  also  excreted  by  these  organs,  after  having 
been  burnt  up;  the  latent  or  potential  energy  of  the  food 
being-  converted  into  kinetic  energv.     The  bodv  loses  in 


180  FOOD  AND  DIETING. 

this  way  about  one-twentieth  of  its  weight  daily,  and 
this  loss  must  be  made  up  from  the  food  ingested. 

By  latent  or  potential  energy  is  meant  the  energy 
capable  of  performing  work  when  called  upon;  such,  for 
example,  as  resides  in  a  suspended  weight.  By  kinetic 
energy  is  meant  energy  which  is  doing  work;  such  as 
the  force  exerted  by  the  weight  in  falling  to  the  ground. 
Heidenhain  calculated  that  four-fifths  of  the  total  energy 
of  the  body  takes  the  form  of  heat.  It  may  be  stated, 
therefore,  that  the  body  is  a  machine  for  converting 
potential  energy  into  kinetic  energy.  The  potential 
energy  is  supplied  by  the  food,  and  the  metabolism  of 
the  body  converts  this  into  the  kinetic  energy  of  heat 
and  mechanical  power. 

Potential  Energy  in  Food. — The  potential  energy 
contained  in  any  substance  is  determined  by  ascertaining 
the  amount  of  heat  that  is  produced  by  its  complete  com- 
bustion. The  potential  energy  contained  in  any  substance 
is  expressed  in  calories.  By  calories  is  meant  the  amount 
of  heat  required  to  warm  i  gram  of  water  i  degree  centi- 
grade. The  amount  of  heat  given  off  by  the  human 
adult  body  per  day  is  equal  to  the  heat  required  to  warm 
2,500,000  grams,  or  2500  kilograms,  of  water  1  degree 
centigrade,  and  this  amount  of  heat  is  generated  by  the 
body  each  day  from  the  food  ingested.  According  to 
Konig,  the  more  common  food-stuffs  have  values  as  fuel 
as  follows: 

I  gram  of  dry  meat  yields 5io3    calories. 

I  gram  of  albumin  yields 499&  " 

I  gram  of  sugar  yields 3227  " 

1  gram  of  starch  (arrowroot)  yields 3912  " 

I  gram  of  butter  yields 7264  " 

I  gram  of  suet  yields 9096  " 

I  gram  of  vegetable  fibrin  yields 6231  " 

1  gram  of  casein  (milk)  yields 5785  " 

I  gram  of  fibrin  (blood)  yields 57°9  " 

I  gram  of  peptone  (Schuhardt)  yields 5334  " 

I  gram  of  glutein  yields 5943  " 

I  gram  of  chondrin  yields 49°9  " 

I  gram  of  urea  yields 2537  " 


POTENTIAL  ENERGY  IN  FOOD.  181 

I  gram  of  Liebig's  meat-extract  yields 3206  calories. 

I  gram  of  fat  (extracted  with  cold  ether)  yields       9686  " 

I  gram  of  fresh  rye  bread  yields 2727  " 

1  gram  of  dry  rye  bread  yields 44-21  " 

I  gram  of  fresh  wheat  bread  yields 2807  " 

I  gram  of  dry  wheat  bread  yields 43°2  " 

The  following  general  estimate  of  the  average  amount 
of  heat  and  energy  in  i  gram  of  each  of  the  classes  of 
nutrients  has  been  made  : 

I  gram  of  proteid  matter  yields      .    .    .  4124  calories,  or  4. 1  kilogram-calories. 

I  gram  of  fats  yields 9321  calories,  or  9.3  " 

I  gram  of  carbohydrates  yields  .    .    .    .  4116  calories,  or  4. 1  " 

When  we  compare  the  nutrients  in  respect  to  their 
fuel  values  with  their  capacities  for  yielding  heat  and 
mechanical  power,  a  gram  of  lean  meat  or  albumin  of 
egg  is  just  about  equivalent  to  i  gram  of  sugar  or  starch, 
and  a  little  over  2  grams  of  either  would  be  required  to 
equal  1  gram  of  fat  meat  or  butter.  These  are  called 
isodynamic  values.  Compared  with  each  other,  100 
grams  of  animal  albumin  are  isodynamic  with  52  grams 
of  fat,  114  grams  of  starch,  or  129  grams  of  dextrose; 
100  grams  of  fat  are  isodynamic  with  243  grams  of  dry 
flesh  or  225  grams  of  dry  syntonin. 

The  food  is  utilized  in  the  body  for  the  following  dif- 
ferent purposes:  To  form  the  tissues  and  fluids  of  the 
body;  to  repair  the  waste  in  the  tissues;  it  is  stored  up 
in  the  body  for  future  consumption;  it  is  consumed  as 
fuel,  its  potential  energy  being  transformed  into  heat, 
muscular  or  other  forms  of  energy;  or,  in  being  con- 
sumed, it  protects  the  tissues  or  other  food .  from  con- 
sumption. 

The  proteid  nutrients  form  tissue,  and  also  serve  as 
fuel ;  the  fats  form  fatty  tissue,  and  also  serve  as  fuel ;  the 
carbohydrates  are  transformed  into  fat  and  serve  as  fuel. 

The  mechanical  energy  obtainable  from  various  arti- 
cles of  food  is  dependent  upon  the  amount  of  potential 
energy  stored  up  in  the  food,  which  is  expressed  in  terms 
of  calories,  and  the  extent  to  which  the  processes  of  the 


1 82  FOOD  AND  DIETING. 

body  can  liberate  and  apply  this  energy.  For  instance, 
a  gram  of  albumin  gives  rise  to  a  certain  amount  of  heat 
when  burned  in  oxygen;  but  in  the  body  thorough  oxi- 
dation does  not  take  place,  because  some  of  the  con- 
stituents of  the  albumin  are  given  off  incompletely  oxi- 
dized in  the  form  of  urea.  A  gram  of  sugar,  on  the 
other  hand,  is  generally  completely  oxidized,  being  con- 
verted into  carbon  dioxid  and  water,  and  its  actual 
energy  in  the  body  is  equal  to  its  theoretical  energy. 
The  mechanical  energy  obtainable  from  the  transforma- 
tion of  albumin  is  arrived  at  by  multiplying  the  number 
of  grams  of  its  several  constituents  by  a  number,  deter- 
mined by  exact  experiment,  representing  the  amount  of 
heat  produced  by  the  oxidation  of  i  gram  of  carbo- 
hydrate, fat,  or  proteid  to  water,  carbon  dioxid,  and  urea. 
According  to  Rubner,  the  average  calorific  value  of 
proteid  matter  is  4124  calories — that  is,  1  gram  of  proteid 
oxidized  to  urea  yields  4124  gram-degrees  (or  4. 1  kilo- 
gram-degrees) of  heat;  1  gram  of  fat  yields  9321  calories 
(9. 3  kilogram-degrees)  ;  and  1  gram  of  carbohydrate 
(starch)  yields  41 16  calories  (4.1  kilogram-degrees).  Ap- 
plying these  numbers  to  Voit's  diet  for  a  man  of  70 
kilos  doing  hard  muscular  work,  we  obtain  in  round 
numbers: 

105  grams  of  assimilated  proteid  x  4.1  =    430  kilogram-degrees. 

56  grams  of  fat  x9-3=     52°  " 

500  grams  of  carbohydrate  x  4.1  =  2050  " 

3000  kilogram-degrees, 

or  3,000,000  calories,  as  the  potential  energy  of  the  food. 
This  amount  may  be  taken  as  the  average  required  for  a 
man.  For  women  the  amount  is  somewhat  less  than 
this,  both  absolutely  and  relatively.  For  children, 
though  absolutely  less,   it  is  relatively  greater. 

Energy  Derivable  from  Food. — In  order  to  calcu- 
late how  much  mechanical  work  can  be  performed  by,  or 
is  equal  to,  the  potential  energy  expressed  in  calories,  we 
must  know  the  relation  between  heat  and  motion. 
According  to   Landois,    the  energy  required  to   heat    1 


ENERGY  DERIVABLE  FROM  FOOD.  183 

gram  of  water  1  degree  centigrade  would  raise  a  weight 
of  425.5  grams  to  a  height  of  1  meter;  or  425.5  grams 
of  water  falling  through  1  meter  would  raise  the  tem- 
perature of  1  gram  of  water  1  degree  centigrade.  The 
mechanical  equivalent  of  the  calorie  is  obtained  by  mul- 
tiplying the  calories  by  425.5,  and  is  expressed  as  a 
gram-meter.  If  we  multiply  the  calorific  value  of  the 
alimentary  principles  by  425.5,  we  obtain  the  mechanical 
energy  of  1  gram  of  each,  as  follows: 

Proteids 4124  x  425.5  =  1754  meter-kilos. 

Fats 9321  x  425.5  =  3966 

Carbohydrates   , 41 16  x  425.5  =  1751  " 

In  order  to  ascertain  the  mechanical  energy  contained 
in  any  diet  we  multiply  the  number  of  grams  of  each 
alimentary  principle  by  the  figures  representing  the 
mechanical  energy  of  each.  Taking  the  standard  diet 
of  Moleschott  for  a  man  performing  moderate  work  we 
obtain  the  following  results: 

Proteids 145  x  1754  =     254,330 

Fats 45  x  3966  =      193,470 

Carbohydrates 605  x  1751  =  1,059,355 

I,5°75IS5  meter-kilos. 

According  to  Hueppe,  the  loss  of  heat  from  the  body 
during  work  is  as  follows: 

Loss  through  radiation  and  conduction 1789  calories. 

Loss  through  evaporation  from  the  skin 384       " 

Loss  through  evaporation  from  the  lungs    ....     192       " 

Total 2365  calories. 

Loss  of  heat  during  rest 1500       " 

Excess  during  work 865  calories. 

He  gives  the  following  dietaries  from  which  he  estimates 
the  amount  of  energy  available  for  mechanical  work: 


1 84 


FOOD  AND  DIETING. 


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ENERG  Y  DERIVABLE  FROM  FOOD.  185 

The  available  energy  for  mechanical  work  in  the  above 
diets  (the  mechanical  equivalent  =  425),  after  deducting 
the  excess  of  heat  lost  during  work,  is  as  follows  : 

Bj  .  .  1266  —  865  =  401  calories  x  425  =  170,425  kgm.  =  14. 5  per  cent. 

B2  .  .  1273— 865  =408  calories  X425  =  173,400  kgm. =  15.0       " 

C   .  .  1419  —  865  =  554  calories x  425  ='235,450  kgm.  =  19.0       " 

D   .  .  1449-865  =  584  calories  x  425  =  248,200  kgm.  =  20.0       " 

The  maximum  day's  work  of  eight  hours,  tested  on  the 
ergograph,  ranges  from  200,000  to  250,000  meter-kilos. 

The  mechanical  energy  present  in  an  ordinary  diet 
may,  therefore,  be  estimated  at  1,250,000  meter-kilos. 
The  work  and  heat  of  the  body  use  up  the  following 
amounts,  according  to  De  Chaumont  : 

Work  of  circulation 75,000  meter-kilos. 

Work  of  respiration 12,000  " 

Calorific  work 781,000  " 

External  work  (93,000  kgm.) 465,000  " 

l>333>000  meter-kilos. 

This  total  is  in  excess  of  the  total  energy  contained  in 
the  standard  diet,  but  this  is  unavoidable,  according  to 
Davies,  "in  calculations  of  such  an  approximate  nature 
as  the  present  one  ;  the  important  point  as  regards  diet- 
ing is  the  proportion  that  should  exist  between  the  differ- 
ent objects  for  which  the  total  energy  is  supplied." 

The  following  may  be  taken  as  an  approximate  basis 
for  the  calculation  of  diets  according  to  size  and  work  : 


Proximate. 

For  subsistence. 

For  work  of  93,000 

meter-kilos  per 

diem. 

For  work  of  100,000 

meter-kilos  per 

diem. 

Aliment. 

Grams  per  kilogram 
of  body-weight. 

Grams  per  kilogram 
of  body-weight. 

Grams  per  kilogram 
of  body-weight. 

Fats 

Carbohydrates    .... 
Salts 

I.O44 
O.4I2 
5.O0O 
O.163 

I.903 
1. 132 

5-937 
0.380 

2.o6 
I.32 

6.38 
O.47 

Total 

6.619 

9-352 

IO.23 

i86 


FOOD  AND  DIETING. 


Dietary  Standards  (Atwater). 


European  standards  for  daily  dietaries. 

Nutrients. 

Fuel 
value. 

Nutri- 
tive ra- 
tio. 

Protein. 

Fats. 

Carbohy- 
drates. 

I 

2 

3 
4 
5 
6 

7 
8 
9 

IO 

" 

12 

13 
15 

Children,  one  to  two  years,  average 

Children,  two  to  six       "              " 

Children,  six  to  fifteen  " 

Aged  woman 

Aged  man 

Woman  at  moderate  work 

Man         (Voit) 

Man         "       hard        "  (Voit) 
Man         "  moderate  "  (Moleschott) 
Man         "          "                (Wolff) 
Subsistence  diet  (Playfair) 
Diet  in  quietude  (Playfair) 
Adults  in  full  health  ( Playfair) 
Active  laborers  (Playfair) 
Hard-worked  laborers  (Playfair) 

Grams 
30.0 
60.O 
85.0 
90.O 

110.0 
100.0 

130.0 

160.0 
i45-o 
140.0 
65.0 
80.0 
130.0 
170.0 
205.0 

Grams. 
40.0 
45  -o 
50.0 

55-o 
75 -o 
50.0 
60.0 

IIO.O 

45-o 
40.0 
15.0 
30.0 
55-o 
80.0 
80.0 

Grams. 
85.O 
220.0 
360.O 
285.O 
385-0 
440.0 
550.0 

495 -o 
605.0 

595-o 
37S-o 
375-o 
185.0 
625.0 
625.0 

Calories. 

765 
I420 
2040 
i860 

2475 
2425 

3055 
3370 
3160 
3°30 
1760 
I950 
3HO 
3630 
3750 

5-7 
5-3 
5-6 
4-7 
5-0 
5-4 
5-3 
4-7 
4-9 
4.9 

6-5 
5-7 
5-4 
4-7 
3-9 

American  Standards. 

i 

2 

3 

4 
5 
6 

Woman  with  light  muscular  exercise 
Woman  with  moderate   "       exercise 
Man  without  muscular  work              ) 
Man  with  light     "             "                  j 
Man  with  moderate  muscular  work 
Man  with  hard 

90 
100 

112 

125 
150 

2400 
2700 

3000 

35O0 
4500 

1  :  5-5 
1:5.6 

1:  5-5 

i:5-8 
1  :  6.3 

The  figures  of  the  foregoing  tables  represent  the 
amounts  of  nutrients  which  different  investigators  have 
estimated  to  be  proper  for  the  daily  food  of  different 
classes.  The  minimum  standard  of  daily  diet,  approxi- 
mately calculated,  may  be  given  as  follows:1 

Minimum  Standard  of  Daily  Diet. 


Child  up  to  one  and  one-half  years  of  age 
Child  from  six  to  fifteen  years     .... 

Man,  at  moderate  labor 

Woman,  at  moderate  labor      

Man,  at  severe  labor 

Man  of  advanced  age       

Woman  of  advanced  age 


Albumin. 

Fat. 

Carbohy- 
drates. 

Grams. 

Grams. 

Gramc. 

20-36 

30-45 

60-90 

70-80 

37-50 

250-4OO 

Il8 

56 

5co 

92 

44 

400 

I20-I45 

loo 

500 

IOO 

68 

350 

So 

20 

260 

According  to  Hueppe,  the  following  reductions  must 
be  made  because  all  of  the  nutritive  materials  in  the  food 
ingested  are  not  absorbed:  In  general  1.5  per  cent,  of  the 

1  Gesundheitsbuchlein,  Berlin,  1896,  Imperial  Board  of  Health. 


ENERG  Y  DERIVABLE  FROM  FOOD. 


187 


albumin  is  not  absorbed.  Of  the  fat  of  pork,  only  98  per 
cent,  is  absorbed;  of  beef,  90  percent.  Mixed  with  meat 
the  digestibility  of  animal  fats  averages  83  per  cent. 
Beef,  with  a  content  of  20.91  per  cent,  of  nitrogenous 
matter  and  5. 19  per  cent,  of  ether  extract,  has  a  gross 
value  as  follows:  100  gm.  =  20.91  X  4124+  5.19  X  9321  = 
86.232  +  48.376  =  134  calories.  If  we  assume  that  the 
digestibility  of  the  albumin  is  97.5  per  cent,  and  that  of 
the  fat  83  per  cent,  then  the  true  value  is  as  follows: 
100  gm.  =  86.232  X  0.975  +  4S-376  X  0.83  =  84.076  + 
40.152  =  124  calories. 

This  calculation  holds  true  for  meat  free  from  bones, 
but  in  the  calculation  of  a  general  dietary  a  reduction  of 
15  per  cent,  must  be  made  for  bones.  One  hundred 
grams  of  commercial  meat  with  15  per  cent,  of  bones 
contain  17.78  percent,  of  nitrogenous  matter  and  4.41 
per  cent,  of  ether  extract;  and  calculated  as  above, 
possess  a  true  value  of  105   calories. 

According  to  von  Reckenberg,  the  digestibility  of 
meat  per  100  grams  of  substance  is  as  follows  : 


f  Medium  fat,  without 

p     ,  bones     

ee    '    1  Medium  fat,  with  15 
I      per  cent,  of  bones 

{Fat,  without  bones  . 
Fat,     with     10     per 
cent,  of  bones  .    . 
A    herring,  135    gm.,   37  per 

cent,  waste 

Fat,  smoked 

Lard,  rendered    


Nitrogenous 
substance. 

(Albumin.) 


Con- 
tent. 


20.91 

17.78 

I4-54 
13.09 

16.07 
2.6 
0.26 


Digesti 
ble. 


20.39 

17-33 

14.18 

12.76 

15.67 

2.54 
0.25 


Ether 
extract. 

(F 

«,) 

Con- 
tent. 

Digesti- 
ble. 

gm. 

gm. 

5-19 

4-31 

4.41 
37-34 

3.66 
30.99 

33-6i 

27.89 

14.36 
77.80 
99.04 

II.92 

64-57 
94.04 

Physiologic 
energy, 
without  1      with 
reference  to  di- 
gestibility. 


Gross 
value. 


Calories. 


132  ! 

112 

409 

368 

199 
742 

934 


True 
value. 

Calories. 


IO4 

348 

313 

174 
617 


The  digestibility  of  the  nitrogenous  substance  can  be 
assumed  to  be  the  same  for  all  kinds  of  meat.    One  gram 


1  In  these  calculations  albumin  is  represented  at  4003,  and  fat  at  9320  calories. 


FOOD  AND  DIETING. 


of  ether  extract  represents  9415  calories  in  pork,  the  bone 
refuse  being  reckoned  as  10  per  cent.  Rendered  swine 
and  beef  fat,  as  well  as  the  fat  of  fish  and  geese,  may  be 
calculated  as  in  the  case  of  pork  fat,  while  the  fat  of 
other  animals  must  be  calculated  as  in  the  case  of  beef. 
In  smoked  fat  1  gram  of  ether  extract  represents  9400 
calories,  because  the  ether  extract  does  not  contain  pure 
fat. 

Nutritive  Value  and  Cost  of  Food. — The  following 
tables  are  based  on  the  tables  in  the  Appendix  of  "  Foods: 
Nutritive  Value  and  Cost,"  by  Prof.  Atwater,  Farmer's 
Bulletin  No.  23,  issued  by  the  U.  S.  Department  of 
Agriculture.     In  each  of  the  tables  the  fuel  value  has 

o 

been  expressed  in  calories  of  the  metric  system  instead 
of  the  amounts  contained  in  the  tables.  The  weight  of 
the  food  materials  has  been  expressed  in  grams  instead 
of  in  ounces  and  pounds.  "Table  B  gives  the  propor- 
tions of  ingredients  in  a  number  of  materials  as  found 
by  analysis  of  specimens  collected  for  the  most  part  in 
New  York  and  New  England  markets." 

Table  A. — Amounts  of  Nutrients  furnished  for  25  cents 
in  Food  Materials  at  Ordinary  Prices. 


Food  materials  as  purchased. 


Beef,  sirloin 

Beef,  round 

Beef,  neck 

Mutton,  leg 

Ham,  smoked 

Salt  pork 

Codfish,  fresh 

Codfish,  dried  salt 

Mackerel,  salt 

Oysters,  25  cents  per  quart  . 
Eggs,  25  cents  per  dozen  .  . 
Milk,  8  cents  per  quart  .  .  . 
Cheese,  whole  milk  .... 
Cheese,  skimmed  milk  .  .  . 
Butter,  25  cents  per  pound  . 
Sugar,  5  cents  per  pound  .    . 

Wheat  flour 

Wheat  bread 

Oatmeal 

Beans 

Potatoes,  60  cents  per  bushel 


Twenty-five 

cents  will  pay  for — 

■O    ui 

O.   H 

0  S 

Nutrients. 

0 

£ 

"5  S 
0  2 

Total. 

Protein. 

Fats. 

Carbo- 
hydrat's 

Grams. 

Grams. 

Grams. 

Grams. 

Grams. 

25 

500 

I55-0 

75-o 

80.0 

16 

780 

235-0 

140.0 

95.0 

8 

1SD5 

465.0 

245.0 

220.0 

20 

625 

190.0 

95.0 

95-o 

16 

780 

385-0 

115.0 

270.0 

10 

1250 

1045.0 

10. 0 

1035.0 

10 

1250 

i35-o 

8 

1565 

255-0 

250.0 

5-o 

10 

1250 

370.0 

185.0 

185.0 

12-5 

1000 

120.0 

65.0 

15.0 

40.0 

14.7 

850 

190.0 

105.0 

85-0 

4 

3125 

385-0 

115.0 

125.0 

145.0 

IS 

835 

545-o 

235.0 

295.0 

15.0 

10 

1250 

675.0 

480.0 

85.0 

110.0 

25 

500 

430.0 

5-o 

425.0 

5 

2500 

2445.0 

2445.0 

2-5 

5000 

4350.0 

55°-o 

55-o 

3745-0 

5 

2500 

1670.0 

220.0 

40.0 

1410.0 

5 

2500 

2260.0 

370.0 

180.0 

1710.0 

5 

2500 

2110.0 

580.0 

50.0 

1480.0 

1 

12,500 

2135.0 

225.0 

10.0 

19 

oc 

.0 

Fuel 
value. 


Calories. 

970 
'335 
2755 
1170 
2705 
8775 

5io 

985 
2275 

520 
i"5 
2030 
3455 
2910 
3615 
9100 
16,450 
6400 
9225 
8075 


NUTRITIVE   VALUE  AND  COST  OF  FOOD.      i< 


Table  B.  —  Composition  of  Different  Food  Materials. 


Food  Materials. 


Animal  foods  as  purchased. 

Beef:  . 

Neck 

Shoulder 

Chuck  rib 

Rib 

Sirloin 

Round  steak      

Side,  without  kidney  fat   .    . 

Rump,  corned 

Flank,  corned 

Veal,  shoulder 

Mutton  : 

Shoulder 

Leg 

Loin      

Side,  without  kidney  fat  .  . 
Pork: 

Shoulder  roast,  fresh  .... 

Ham,  salted,  smoked      .    .    . 

Chicken 

Turkey 

Eggs,  m  shell 

Fish,  etc.  : 

Flounder,  whole 

Bluefish,  dressed 

Codfish,  dressed 

Shad,  whole  ....'.... 

Mackerel,  whole 

Halibut,  dressed 

Salmon,  whole      

Salted  codfish 

Smoked  herring 

Salted  mackerel 

Canned  salmon 

Lobsters      

Oysters 

Animal  foods,  edible  portion. 

Beef: 

Neck 

Shoulder 

Chuck  rib 

Rib 

Sirloin 

Round     

Side,  without  kidney  fat    .    . 

Rump,  corned 

Flank,  corned 

Veal,  shoulder 

Mutton  • 

Shoulder 

Leg 

Loin      

Side,  without  kidney  fat  .  . 
Pork: 

Shoulder  roast,  fresh  .... 

Ham,  salted,  smoked     .    .    . 

Fat,  salted 

Sausage  : 

Pork 

Bologna \   .   .   . 

Chicken 


s 

O    -J 


1=1-5 


Edible  portion. 


49.6 
55-8 
49-S 
38.2 

48.3 
60.9 

44-3 
70.8 
43-7 
56.7 

49 
50.6 

4i-5 
44.2 

43 

36.8 

44.6 

44-7 

63-1 

27.2 

43 

58.5 

35-2 

40.4 

6..9 

40.6 

40.5 

19.2 

28.1 

59.3 

3i 

15-4 


62 

63.9 

58 


Nutrients. 


30.4 
31.6 

35-9 
40.8 
32.2 
3'-3 
36.5 
24.2 
44.2 
25.4 

34  7 
3'-3 
42.7 
38.5 


17.2 
22.9 
23.2 

6 

11. 1 
11. 6 
*4-7 
15 

20.4 
24.1 
17.6 
29.9 
3i-5 
35.8 
6.9 
2-3 


38 

36.1 

42 

51.9 

40 

31.8 

45.2 

41.9 

50.2 

31-2 

41.4 
38.2 

5°-7 
46.5 

49-7 
58.5 
87.9 

58.8 
37-6 
27.8 


15-6 

17 


15 

18 

13.9 

16.7 

12.4 

16.6 


1  + 

13.6 
14.8 
15.1 
16. 1 
12. 1 

5-2 
9.8 
10.6 
9.2 
10 
15.1 
'4-3 
16 

20.2 

'4-7 

19-3 

5-5 

1.1 


15 
16  9 

16 
16.7 

•9 

13-8 
18.8 
24.4 


14 
13-7 

20.1 

27-9 

16.4 

123 
21.8 

5-1 

29.2 

7-9 


15.6 
29.5 
23-7 

28 
34-6 
1.2 

5-9 


•3 

.6 

.2 

4.8 

4-3 

4-4 


15.1 
15-3 

•7 


17-5 
15.6 
23-5 
35-6 
20.5 
10. 1 


33 

9.8 

22.4 
19 

35 
28.7 

32.8 
39.1 
82.8 

42.8 
15.8 


1.2 
-9 


3 

1.2 


Cal. 

880 
895 

1125 

1405 
970 
855 

1180 
525 

1460 
640 

1075 

935 

1480 
1260 

1435 
1735 
33° 
550 
655 

no 
210 
205 
375 
365 
465 
635 
3i5 
7+5 
910 
1005 

135 
40 


1 100 
1020 
1320 

1790 
1210 

805 
1465 
1370 
1655 

790 

1280 
1140 
1755 
1525 

1680 
i960 
3510 

2065 
1015 
540 


190 


FOOD  AND  DIETING. 


Table  B  {continued). 


Food  Materials. 


Turkey 

Eggs 

Milk 

Butter 

Oleomargarin  .  .  . 
Cheese : 

Full  cream      .    . 

Skimmed  milk  . 
Fish: 

Flounder     .    .    . 

Haddock     .    .    . 

Codfish    .... 

Shad 

Mackerel     .    .    . 

Halibut    .... 

Salmon     .... 

Salted  cod  .    .    . 

Herring,  salted 

Mackerel,  salted 

Oysters   .... 


Vegetable  foods. 

Wheat  flour 

Graham  flour  (wheat)     .    . 

Rye  flour 

Buckwheat  flour 

Oatmeal  .     • 

Cornmeal 

Rice 

Peas 

Beans 

Potatoes 

Sweet  potatoes      

Turnips 

Carrots 

Onions 

String  beans 

Green  peas 

Green  corn 

Tomatoes 

Cabbage      

Apples     .     ■ 

Sugar,  granulated    .... 

Molasses 

White  bread  (wheat)  .    .    . 
Boston  crackers    ..... 


,3  "5 

Pi 


Edible  portion. 


73.8 

87 
10.5 


30.2 
4'-3 


Nutrients. 


33-8 
26.2 
*3 


69.8 
58.7 


18.3 

17  4 
29.4 
26.6 
24.6 
36.4 


87.5 


8.7 

i°-5 


35-5 
6.8 


7-i 

3-3 

•4 

i-7 


.6  I   16 

1.1  13 

•4  2 

•3  5 

•4  15 

•  •  97 

•  •  73 
1.7  56 
9.9  i  68 


1  8 
8.9 


4-2 
4.6 


i-4 

•4 

2.9 

3-1 


810 

721 

325 

3615 

3605 

2070 
1165 

285 
325 
310 

745 
640 
560 
965 
410 
I34S 
i860 
1230 


1645 
1625 
1625 
1605 
1850 
1645 
1630 
1565 
1615 
375 
53° 
185 
200 
225 

235 
405 

345 

80 
155 
315 
1820 
1360 
1280 
1895 


Digestibility  of  Foods. — In  general,  the  animal  foods 
are  somewhat  more  digestible  than  the  vegetable  foods. 
The  proteid  matter  of  ordinary  meats,  for  instance,  is 
practically  all  digested  when  eaten  in  moderate  quanti- 
ties by  healthy  persons  (97.5  per  cent.);  but  the  same 
person  might  digest  only  nine-tenths  of  the  proteid  mat- 
ter of  wheat,  and  not  more  than  three-fourths  of  that  of 
potatoes.     The  fat  of  meats  is  less  completely  digested. 


DIGESTIBILITY  OF  FOODS.  191 

The  sugar  and  starch  of  vegetables,  when  they  are 
properly  cooked,  is  very  easily  and  completely  digested. 

According  to  the  experiments  of  De  Chaumont  on 
Alexis  St.  Martin,  the  digestibility  of  different  food  sub- 
stances ranges  itself  in  the  following  order:  "  Rice,  tripe, 
whipped  eggs,  sago,  tapioca,  barley,  boiled  milk,  raw 
eggs,  lamb,  parsnips,  roasted  and  baked  potatoes,  and 
fricasseed  chicken  are  most  easily  digested  in  the  order 
given — the  rice  disappearing  from  the  stomach  in  one 
hour,  and  the  fricasseed  chicken  in  two  and  three-fourths 
hours.  Beef,  mutton,  pork,  oysters,  butter,  bread,  veal, 
boiled  and  roasted  fowls  are  rather  less  digestible,  roast 
beef  disappearing  from  the  stomach  in  three  hours,  and 
roast  fowl  in  four  hours.  Salted  beef  and  pork  disappear 
in  four  and  a  quarter  hours." 

The  following  list  (Chambers)  shows  the  relative  digesti- 
bility of  different  articles  of  food:  "Roast  mutton,  sweet- 
bread, boiled  chicken,  venison,  soft-boiled  eggs,  new 
toasted  cheese,  roast  fowl,  turkey,  partridge  and  pheasant, 
lamb,  wild  duck,  oysters,  periwinkles,  omelette,  tripe, 
boiled  sole,  haddock,  skate,  trout,  perch,  roast  beef, 
boiled  beef,  rump  steak,  roast  veal,  boiled  veal,  rabbit, 
salmon,  mackerel,  herring,  pilchard,  sprat,  hard-boiled 
and  fried  eggs,  pigeon,  hare,  duck,  goose,  fried  fish, 
roast  and  boiled  pork,  heart,  liver,  kidneys,  lobster, 
salted  fish,  crab." 

The  digestibility  of  food  depends  upon  the  nature  of 
the  food  substance,  its  hardness  and  cohesion,  and  on  its 
chemical  nature,  as  well  as  on  the  degree  to  which  it  is 
altered  by  cooking.  It  is  also  dependent  upon  the  indi- 
vidual characteristic  of  each  person,  the  digestive  power 
of  the  organs  of  digestion.  The  admixture  of  different 
classes  of  foods  also  aids  digestion;  some  of  the  accessory 
foods  probably  causing  an  increased  flow  of  the  digestive 
fluids.  The  degree  of  fineness  of  the  food  and,  conse- 
quently, the  thoroughness  of  mastication  are  important 
factors  in  favoring  digestion.  The  amount  of  food  taken 
at  a  time  also  plays  an  important  influence  in  digestion. 


192  FOOD  AND  DIETING. 

Composition  of  Foods. — The  ordinary  food  materials 
consist  of  refuse  matter,  such  as  the  bones  of  meat  and 
fish,  the  shells  of  shellfish,  the  skin  of  potatoes,  and  the 
bran  of  wheat;  and  of  proteid  matter,  fats,  carbohydrates, 
and  salts. 

Prof.  Atwater,  in  his  reports  on  the  chemical  composi- 
tion of  food  materials,  uses  the  term  "protein,"  which 
"includes  nominally  the  total  nitrogenous  substance  of 
animal  and  vegetable  food  materials,  exclusive  of  the  so- 
called  nitrogenous  fats."  The  term  "proteid,"  as  used 
in  the  same  reports,  "includes  (i)  the  simple  proteids,  e. 
g.,  albuminoids,  globulins  and  their  derivatives,  such  as 
acid  and  alkali  albumins,  coagulated  proteids,  proteoses, 
and  peptones;  (2)  the  so-called  combined  or  compound 
proteids;  (3)  the  so-called  gelatinoids  (sometimes  called 
'  glutinoids '),  which  are  .characteristic  of  animal  con- 
nective tissue."  The  term  "albuminoids"  is  used  as  a 
"collective  designation  of  the  substances  of  the  first  two 
groups,  though  many  apply  it  to  all  three  of  these  groups. 
Of  late  a  number  of  investigators  and  writers  have 
employed  the  term  as  a  special  designation  for  com- 
pounds of  the  third  class."  The  term  "  non-proteid  " 
is  "  used  synonymously  with  the  term  non-albuminoid," 
and  includes  nitrogenous  animal  and  vegetable  com- 
pounds of  simpler  constitution  than  the  proteids.  The 
most  important  animal  compounds  of  this  class  are  the 
so-called  "nitrogenous  extractives"  of  muscular  and 
connective  tissue,  such  as  creatin,  creatinin,  xanthin, 
hypoxanthin,  and  allied  cleavage  products  of  the  pro- 
teids. The  non-proteid  nitrogenous  compounds  in  vege- 
table foods  consist  of  amids  and  amido-acids,  of  which 
asparagin  and  aspartic  acid  are  familiar  examples. 

The  total  nitrogenous  substance  is  estimated  by  deter- 
mining the  amount  of  nitrogen  present  and  multiplying 
the  product  by  the  factor  6. 25. 

The  fats  include  the  true  vegetable  and  animal  fats, 
such  as  the  fat  of  fat  meat,  the  fat  of  milk,  olive  oil, 
cottonseed  oil,  etc.,   and  various  other  substances,  such 


COMPOSITION  OF  FOODS.  193 

as  the  fatty  acids,  lecithins  (nitrogenous  fats),  and  the 
chlorophyls.  The  fats  contain  about  75  per  cent,  of 
carbon.  Under  carbohydrates  are  included  the  different 
sugars,  starches,  gums,  and  cellulose,  or  woody  fiber. 
These  substances  are  found  most  plentifully  in  the 
cereals,  as  wheat,  oats,  corn,  rye,  and  barley,  in  the 
Leguminosae,  and  in  the  different  roots,  tubers,  and  green 
vegetables. 

Under  mineral  foods  are  included  water,  phosphates, 
sulphates,  chlorids,  and  other  salts  of  potassium,  sodium, 
magnesium,  and  other  metallic  elements.  Of  these, 
sodium  chlorid  is  the  most  important,  its  presence 
exciting  assimilative  changes  and  assisting  in  the  secre- 
tion of  many  of  the  digestive  fluids,  especially  of  the 
gastric  juice;  and  so  necessary  is  it  to  the  organism  that 
when  it  is  supplied  in  insufficient  quantity  it  is  retained 
by  the  tissues  and  not  excreted.  When  deprived  of  it 
animals  lose  in  weight  and  activity.  The  potassium 
salts  are  also  indispensable,  acting  as  exciters  of  the 
nervous  system  and  increasing  the  cardiac  pulsations. 
The  phosphates  are  of  importance  because  of  the  large 
amounts  required  to  maintain  the  normal  condition  of 
the  bones. 

Functions  of  the  Alimentary  Principles  of  Food. 
— The  various  nitrogenous  substances  in  foods  serve  the 
following  purposes  when  taken  into  the  system:  Forma- 
tion and  repair  of  the  tissues  and  fluids  of  the  body;  the 
regulation  of  the  absorption  and  utilization  of  oxygen; 
and  they  serve  as  regulators  of  digestion  and  assimilation, 
especially  with  reference  to  the  gelatin  group. 

Of  the  non-nitrogenous  substances  in  foods,  the  fats 
serve  to  supply  fatty  tissues  and  as  nutrition  to  the 
nervous  system.  They  also  supply  energy  and  animal 
heat  by  oxidation.  The  carbohydrates  also  serve  to 
supply  energy  and  animal  heat  by  oxidation,  and  they 
are  converted  into  fat  by  deoxidation,  and  stored  in  the 
body  for  future  use.  The  vegetable  acids  serve  to  main- 
tain the  alkalinity  of  the  blood  by  conversion  into  car- 

13 


194  FOOD  AND  DIETING. 

bonates,  and  to  furnish  a  small  amount  of  energy  or 
animal  heat  by  oxidation. 

The  mineral  matters  of  food  serve  to  support  the  bony 
skeleton,  supply  hydrochloric  acid  for  digestion,  also  as 
regulators  of  energy  and  nutrition. 

In  addition  to  the  four  alimentary  principles  in  food, 
several  groups  of  substances,  which  are  not  included  in 
this  classification,  must  also  be  mentioned.  These  are 
the  condiments  and  beverages.  The  condiments  are  of 
importance  because  they  serve  to  give  flavor  to  food,  and 
stimulate  secretion  and  digestion,  though  they  have  but 
little  direct  influence  in  forming  tissue  or  in  supplying 
energy  and  heat. 

Water  as  Food. — Since  water  forms  about  two-thirds 
of  the  weight  of  the  body,  a  great  deal  of  fluid  must  be 
taken  into  the  system  in  order  to  balance  the  constant 
loss  through  the  excretions.  This  fluid  is  in  part  sup- 
plied by  the  food  as  usually  prepared,  but  a  large  pro- 
portion must  be  supplied  directly  as  water  or  in  the  form 
of  some  beverage,  as  tea,  coffee,  milk,  or  some  of  the 
alcoholic  or  non-alcoholic  beverages.  The  quantity  of 
water  required  daily  by  an  adult  person  is  usually  stated 
as  3  liters,  of  which  i  liter  is  contained  in  the  food  in- 
gested, and  the  other  2  liters  must  be  supplied  in  the 
form  of  plain  water  or  one  or  other  of  the  beverages 
named. 

A  deficient  supply  of  water,  or  fluid  of  any  kind,  tends 
to  induce  affections  of  the  kidneys  and  bladder  from  the 
concentrated  condition  of  the  blood  and  excreta.  It  also 
manifests  itself  in  diminished  nervous  activity. 

The  supply  of  fluid  taken  should  be  so  regulated  as  not 
to  interfere  with  digestion.  Large  quantities  of  fluid 
taken  with,  or  shortly  after  the  meals,  will  dilute  the 
gastric  juice  to  such  an  extent  as  to  retard  digestion,  and 
thus  lead  to  disturbances  of  the  digestive  function.  Tea 
and  coffee  cannot  be  regarded  as  nutriment  in  the  sense 
of  supplying  material  to  maintain  structure  and  generate 
heat.     Tea  tends  to  excite  vital  activity,  acting  particu- 


ANIMAL  FOODS;  ME  A  T.  195 

larly  as  a  respiratory  stimulant.  Coffee  also  excites  the 
nervous  system.  It  exerts  a  marked  sustaining  influence 
under  fatigue  and  privation,  and  appears  to  diminish  the 
waste  of  the  tissues.  Both  tea  and  coffee,  as  usually 
consumed,  with  sugar  and  milk,  are  useful  as  food. 
Alcohol  and  the  alcoholic  beverages,  according  to  the 
testimony  of  Prof.  Atwater,  serve  as  sources  of  animal 
heat,  and  in  this  sense  may  be  regarded  as  food  materials, 
aside  from  the  salts  and  extractives  contained  therein. 


DIFFERENT  VARIETIES  OF  FOOD. 

Animal  Foods;  Meat. —  The  flesh  of  herbivorous 
animals  is  most  commonly  used  for  food,  though  that  of 
the  pig,  an  omnivorous  animal,  is  also  used  extensively 
in  some  countries.  The  flesh  of  young  animals  is  more 
tender,  because  there  is  less  connective  tissue  between 
the  different  muscular  bands.  Atwater  has  found  that 
meat  and  fish  are  digested  to  the  same  extent  by  healthy 
men.  The  meat  derived  from  young  animals  is  less 
easily  digested  than  that  of  older  animals.  Cooked  meat 
is  more  difficult  of  digestion  than  raw  meat.  The  meat 
of  females  is  also  more  tender  and  less  coarse  than  that 
of  males.  The  flesh  of  wild  animals  is  less  fatty,  higher 
in  color,  and  richer  in  flavor  and  extractives  than  that  of 
domestic  animals. 

The  nitrogenous  substances  of  meat  are  albumin, 
creatin,  creatinin,  sarkin,  xanthin,  inosin,  uric  acid,  and 
urea.  The  muscular  sheaths  and  connective  tissue  con- 
tain also  myosin.  The  proportion  of  albumin  ranges 
from  0.6  to  4.56  per  cent.;  Iyiebig  gave  the  average 
amount  as  2.96  per  cent  Prof.  Mallet  has  found,  as  the 
result  of  numerous  experiments,  that  the  creatinin  is 
excreted  unchanged,  while  the  creatin  is  changed 
wholly  or  very  largely  to  creatinin,  and  consequently  he 
believes  these  two  substances  cannot  be  regarded  as 
sources  of  energy,  being  excreted  practically  without 
having:   undergone   chang;e.     The    influence    of    creatin 


196  FOOD  AND  DIETING. 

in  the  system,  according  to  Konig,  is   to  stimulate  the 
nervous  system. 

The  average  composition  of  albumin  may  be  taken  as 
follows:  In  100  parts,  nitrogen  16,  carbon  54,  oxygen  22, 
hydrogen  7,  and  sulphur  1.  In  the  group  of  substances 
headed  by  gelatin  the  proportion  of  nitrogen  (=  18  per 
cent.)  to  carbon  is  greater,  and  these  substances  are  much 
less  nutritious  than  the  albuminates  proper. 

Diseases  Produced  by  Diseased  Meat. —  All  animals 
slaughtered  for  food  should  be  free  from  disease.  Cer- 
tain diseases  from  which  the  domestic  animals  suffer 
are  directly  communicable  to  man;  others  are  not  directly 
communicable  to  man,  but  the  flesh  of  the  animals  suf- 
fering from  them  is  unfit  for  food.  The  inspection 
should  be  made  both  before  and  after  slaughtering. 

The  diseases  of  cattle  which  render  their  flesh  unfit  for 
food  are  epidemic  pleuropneumonia,  foot-and-mouth 
disease,  Texas  cattle  fever,  rinderpest,  anthrax,  actino- 
mycosis, and  tuberculosis.  Dropsical  conditions,  as  well 
as  all  inflammatory  conditions,  also  render  the  flesh  unfit 
for  food.  The  diseases  of  the  pig  which  render  the  flesh 
unfit  for  food  are  anthrax,  muco-enteritis,  hog-cholera, 
tuberculosis,  Cysticercus  cellulosa,  the  so-called  measles 
of  the  pig,  and  Trichina  spiralis. 

Meat  Inspection. — Some  of  the  diseases  of  the  domestic 
animals  can  be  recognized  before  death,  but  most  of 
them  must  be  detected  by  post-mortem  examination, 
either  by  general  inspection  of  the  carcass  and  of  the 
organs  and  different  portions  of  the  body,  or  by  micro- 
scopic examination. 

The  general  inspection  includes  the  observation  of  the 
nature  and  the  quantity  of  fat,  the  color,  odor,  and  con- 
sistence of  the  muscles,  condition  of  the  bone-marrow, 
and  the  condition  of  the  lungs,  liver,  spleen,  kidneys, 
and  the  lymphatic  glands. 

There  should  not  be  an  excessive  amount  of  fat,  or 
else  the  proportion  of  proteid  matter  will  be  too  low;  it 
should  be  firm  and  not  too  yellow,  and  without  hemor- 


ANIMAL  FOODS;  MEAT.  197 

rhagic  foci.  The  color  of  the  fat  will  vary  somewhat 
with  the  age,  breed,  and  color  of  the  animal,  and  the 
kind  of  food. 

The  muscles  should  be  firm  yet  elastic.  They  should 
be  tolerably  dry  and  have  a  pleasant  odor.  There  should 
be  no  lividity  or  cutting  across  some  of  the  muscles.  A 
purple  color  may  be  indicative  that  the  animal  has  not 
been  slaughtered,  or  that  it  suffered  from  some  acute 
disease.  There  should  be  a  marbled  appearance  from  the 
ramification  of  connective  tissue  and  fat  between  the 
muscular  bundles. 

The  bone-marrow  of  the  hind  legs  is  of  a  light  rosy- 
red  color,  and  remains  solid  for  about  twenty-four  hours 
after  death.  If  it  is  soft,  brownish,  or  with  dark  points, 
the  animal  may  have  been  sick,  or  putrefaction  may  be 
commencing.  The  marrow  of  the  fore  legs  is  somewhat 
softer  and  of  a  rose-red  color. 

The  internal  organs  should  be  carefully  inspected  for 
the  presence  of  tumors,  parasites,  or  suppuration.  The 
lungs  and  pleurae  will  usually  show  the  presence  of  tuber- 
culosis, through  the  deposition  of  tubercles.  Sometimes 
these  are  found  first  in  the  lymphatic  glands  of  the  mesen- 
tery and  mediastinum. 

The  microscopic  examination  of  meat  is  directed  prin- 
cipally toward  the  detection  of  parasites,  such  as  the 
cysticercus,  psorospermia,  and  trichina.  The  cysticercus 
may  be  found  in  the  flesh  of  cattle  and  pigs;  the  psoro- 
spermia in  the  flesh  of  cattle,  sheep,  and  pigs;  and  the 
trichina  in  the  flesh  of  pigs.  A  power  of  from  25  to  50 
diameters  is  sufficient  to  detect  these  parasites  in  meat. 

Method  of  Meat  Inspection. — The  method  of  meat  in- 
spection, and  the  restrictions  placed  upon  the  sale  of  the 
meat  of  diseased  cattle,  differ  very  greatly  in  different 
countries.  For  instance,  Saxony  and  Bavaria,  in  Ger- 
many, Italy,  Russia,  and  Denmark  allow  the  sale  of  the 
meat  of  tubercular  animals  when  the  disease  has  not 
become  generalized,  providing  it  is  sold  with  the  under- 
standing that  it  is  derived  from  diseased  animals,  or  is  sold 


198  FOOD  AND  DIETING. 

as  second-class  meat.  In  most  foreign  countries,  as  well 
as  in  the  United  States,  the  meat  of  tubercular  animals  is 
sold  without  any  declaration  as  to  its  nature  as  whole- 
some meat  when  the  disease  is  localized. 

In  the  United  States  the  inspection  of  meat  is  in 
charge  of  the  national  government.  Meat  inspectors  are 
stationed  at  the  slaughter-houses  of  all  large  cities,  and 
each  carcass  is  inspected  as  soon  as  slaughtered.  This 
system  of  inspection  should  be  extended  so  as  to  include 
towns  of  smaller  size,  because,  especially  in  the  West, 
three,  four,  or  more  small  slaughter-houses  are  clustered 
on  the  outskirts  of  small  towns,  and  each  becomes  a 
source  of  the  dissemination  of  disease. 

Meat  intended  for  export  is  always  subjected  to  rigid 
inspection.  All  pork  intended  for  exportation  is  ex- 
amined microscopically  for  the  presence  of  the  Trichina 
spiralis.  This  inspection  is  made  by  the  Federal  authori- 
ties at  the  slaughter-house.  Most  of  this  work  is  done 
at  Chicago.  In  most  cities  of  the  United  States  the  meat 
intended  for  local  consumption  is  inspected  very  super- 
ficially or  not  at  all.  Francis  Vacher,  in  a  paper  pre- 
sented to  the  Seventh  International  Congress  of  Hygiene, 
on  "  The  Inspection  of  Meat  with  regard  to  the  Preven- 
tion of  Disease,"  treats  of  the  subject  under  the  follow- 
ing headings: 

I.  The  general  provision  of  public  abattoirs. 

II.  The  closing  of  private  slaughter-houses. 

III.  The  licensing  and  registering  of  all  butchers  and 
their  premises. 

IV.  The  appointment  of  competent  inspectors  of  meat. 

V.  The  general  systematic  inspection  of  animals  and 
meat  to  be  used  for  the  food  of  man. 

VI.  The  appointment  of  competent  assessors  to  sit 
with  magistrates  and  assist  them  when  necessary  in  the 
hearing  of  cases  relating  to  diseased  meat. 

Ostertag1  mentions  the  following  points  as  forming  the 

1  Trans.  Gemian  Veterinary  Council  for  1 89 1. 


ANIMAL  FOODS;  MEAT.  199 

foundation  upon  which  the  rules  governing  the  question 
of  meat  inspection  must  be  based: 

1.  The  erection  of  public  slaughter-houses  in  all  cities 
of  more  than  5000  inhabitants. 

2.  Compelling  the  butchers  to  kill  their  animals  in 
these  slaughter-houses,  and  to  discontinue  the  use  of 
private  slaughter-houses. 

3.  Professional  direction  of  the  slaughter-houses,  and 
the  inspection  of  all  animals  both  before  and  after  the 
slaughter. 

4.  The  provision  of  stalls  for  the  sale  of  inferior  but 
not  unhealthy  meat  (not  apt  to  cause  disease  in  man), 
such  as  meat  of  an  abnormal  color,  odor,  bloody  meat, 
and  that  from  sick  animals.  The  provision  of  a  cooking 
or  sterilizing  apparatus,  for  cooking  such  meat  as  might 
cause  disease  if  consumed  raw,  but  would  be  harmless 
when  cooked  (meat  containing  cvsticerci,  trichina,  and 
tubercle  bacilli). 

5.  The  total  destruction  of  those  animals  and  parts  of 
animals  which  are  condemned  as  unfit  for  food. 

6.  The  formation  of  a  co-operative  insurance  society 
for  the  purpose  of  recompensing  the  owners  of  condemned 
cattle.  It  is  best  that  this  society  should  be  conducted 
by  the  city  or  town,  in  order  that  the  losses  might  be 
regularly  distributed. 

It  seems  evident,  from  the  experiments  of  Woodhead 
and  others,  that  there  is  positive  danger  from  the  use  of 
meat  of  tubercular  animals  even  though  the  disease  has 
not  been  generalized.  The  point  which  seems  to  be 
entirely  overlooked,  and  to  which  a  great  deal  of  impor- 
tance should  be  attached,  is  that  when  the  disease  is 
localized  in  one  or  more  organs  there  is  great  danger  of 
infecting  the  entire  carcass  by  the  butcher's  knife  in  re- 
moving these  infected  organs.  Not  only  may  the  carcass 
containing  the  tubercular  nodules  become  infected  in  this 
manner,  but  the  infection  may  also  be  carried  on  the 
butcher's  knife  to  the  carcasses  of  other  animals  slaug-h- 
tered  by  him. 


200  FOOD  AND  DIETING. 

Putrefactive  Changes  in  Meat — One  of  the  most  serious 
effects  produced  by  the  consumption  of  meat  is  the  result 
of  putrefactive  changes.  Meat  that  was  originally  sound 
may  be  invaded  by  certain  species  of  putrefactive  bacteria 
which  generate  poisonous  ptomains  in  the  meat  as  the 
result  of  their  metabolism.  Preserved  meats,  such  as 
canned  meats,  and  sausages,  are  especially  liable  to  un- 
dergo such  a  change.  In  1895  Van  Ermengen  discovered  an 
anaerobic  bacillus  in  tainted  meat,  which  has  been  named 
Bacillus  botulinus.  This  bacillus  produces  a  highly 
toxic  poison  in  meat  which,  when  taken  into  the  system, 
has  an  especial  affinity  for  the  nervous  system,  and  hence 
the  character  of  the  symptoms  seen  in  poisoning  from 
tainted  meat.  Kemperer  has  found  that  it  is  possible  to 
counteract  these  symptoms,  at  least  in  part,  by  means  of 
an  antitoxin  derived  from  the  blood  of  animals  immunized 
against  the  bacillus.  Experiments  have  shown  that  dogs 
are  immune  against  this  organism  even  when  fed  in  their 
food  in  pure  cultures. 

Preservation  of  Meat. — Meat  can  be  preserved  in  its 
normal  state  in  cold  climates  for  a  week  or  more  with- 
out undergoing  any  change  detrimental  to  health.  In 
warm  climates  it  cannot  be  preserved  longer  than  a  day 
or  two  without  resorting  to  some  method  to  prevent  the 
action  of  the  bacteria  of  putrefaction.  The  methods  in 
common  use  for  this  purpose  are  desiccation,  sterilization 
by  heat,  refrigeration,  salting,  and  the  use  of  antiseptic 
substances, — that  is,  substances  which  prevent  the  de- 
velopment and  action  of  putrefactive  bacteria. 

Desiccation  takes  away  the  moisture  and  thus  prevents 
the  entrance  of  bacteria.  In  some  exceptionally  dry  cli- 
mates desiccation  takes  place  on  simple  exposure  to  the 
atmosphere.  Ordinarily,  however,  the  desiccation  must 
be  brought  about  bv  artificial  heat.  In  common  practice 
the  process  is  conducted  in  a  smoke-house,  where  the 
products  of  combustion  assist  in  preserving  the  meat. 

Sterilization  by  heat  is  commonly  resorted  to  in  the 
household  where    other  methods  of  preserving   are  not 


ANIMAL  FOODS;  MEAT.  201 

available.  This  method  is  also  employed  commercially, 
and  the  sterilized  meat  is  preserved  in  hermetically  sealed 
receptacles,  in  which  it  keeps  indefinitely.  The  so- 
called  "  canned  meat"  used  for  the  army  during  the 
late  war  is  a  form  of  preserved  meat.  When  the  recep- 
tacle is  once  opened  the  meat  soon  undergoes  decom- 
position. 

Salting  is  one  of  the  oldest  methods  of  preserving  meat. 
The  action  of  the  salt  is  to  remove  moisture,  to  harden 
the  muscle-fiber,  and  it  is  also  to  some  extent  an  anti- 
septic. 

The  use  of  various  antiseptic  substances  for  the  preserva- 
tion of  meat  is  of  recent  date.  Since  all  antiseptic  sub- 
stances are  to  some  extent  poisonous,  they  should  not  be 
employed  for  this  purpose.  Meat  that  has  been  preserved 
by  means  of  antiseptic  substances  is  not  only  poisonous 
because  of  the  antiseptics  contained  in  it,  but  it  is  also 
objectionable  because  these  antiseptics  render  it  tough 
and  indigestible,  and  therefore  irritant  to  the  gastro- 
intestinal tract.  The  antiseptic  substances  employed  for 
this  purpose  are  boric  and  salicylic  acids,  sodium  sulphite, 
and  formaldehyd.  All  of  these  substances  hinder  the 
process  of  digestion  and  are  therefore  harmful. 

The  only  safe  and  rational  method  of  preserving  meat 
is  by  refrigeration.  By  this  means  meat  can  be  stored 
for  a  considerable  time  or  shipped  long  distances  without 
suffering  in  character  or  digestibility. 

Smoked,  salted,  and  sterilized  meats  are  far  more  diffi- 
cult to  digest,  besides  being  less  palatable  and  less  nutri- 
tious than  fresh  meat.  Meat  preserved  by  sterilization  is 
less  nutritious  and  less  palatable  than  fresh  meat,  and  it 
is  also  less  nutritious  because  it  is  overcooked. 

Detection  of  Meat  Preservatives. — A.  Beythien  and  H. 
Hempel1  tested  the  Jorgensen  method  of  estimating  boric 
acid  in  meat  preservatives.  This  method  is  based  upon 
the  fact  that  a  watery  solution  of  boric  acid,  neutral 
to  phenolphthalein,  after  being  treated  with  a  sufficient 

1  Abst.  in  Hyg.  Rundschau,  Bd.  x.,  S.  744. 


202  FOOD  AND  DIETING. 

quantity  of  glycerin,  again  takes  on  an  acid  reaction, 
and  that  by  subsequent  titration  with  caustic  alkali  solu- 
tion the  amount  of  boric  acid  can  be  estimated  if  the  value 
of  the  alkali  solution  has  been  carefully  determined. 

The  samples  of  meat  treated  with  known  amounts  of 
boric  acid  are  made  strongly  alkaline  by  means  of 
caustic  soda  solution,  and  then  extracted  for  several 
hours  with  hot  water.  The  filtrate  is  evaporated  to 
dryness,  incinerated,  and  the  ash  dissolved  in  sulphuric 
acid.  This  solution  is  gently  warmed  for  some  time  to 
remove  the  carbon  dioxid,  and  after  cooling  is  accu- 
rately neutralized  to  phenolphthalein. 

The  fluid,  about  50  c.c.  in  amount,  is  then  treated  with 

n 

2^  c.c.  of  glvcerin  and  titrated  with  —  NaHO  solution 
o  &  .  IO 

without  regard  to  the  phosphates  that  may  be  precipi- 
tated; the  end-reaction  is  made  more  definite  by  the 
addition  of  ethyl  alcohol.  In  this  manner  94.94  per 
cent,   of  the  boric  acid  added  was  recovered. 

Borutrager  makes  the  following  statements  with  regard 
to  the  use  of  sodium  sulphite  (Na2S03)  as  a  meat  preserv- 
ative:1 "The  extensive  use  of  food  preservatives  is  not 
generally  recognized  by  the  physician.  The  continued 
use  of  food  substances  preserved  in  this  manner  is  detri- 
mental to  health. 

"When  sodium  sulphite  is  present  in  food  sulphurous 
acid  gas  is  liberated  in  the  stomach  through  the  action 
of  the  hydrochloric  acid  of  the  digestive  fluid,  and  this 
leads  to  strong  local  irritation.  The  salt  also  acts  in  the 
organism  as  a  free  acid. 

"After  eating  Frankfurt,  Vienna,  or  Bock  sausage, 
or  drinking  the  so-called  Rhine  or  Moselle  wines,  there 
was  eructation  of  sulphurous  acid  and  hydrogen  sulphid, 
with  pressure  and  discomfort  in  the  stomach,  and  head- 
ache, which  lasted  a  considerable  time." 

Cooking. — The  value  of  meat  as  served  on  the  table  is 
influenced   to   a    considerable  extent  by  the  manner  in 

1  Abst.   Hyg.  Rundschau,  Bd.  x.,  S.  743. 


ANIMAL  FOODS;  MEAT.  203 

which  it  is  cooked.  The  object  of  cooking  meat  is  to 
render  it  more  easy  of  mastication  and  digestion,  and  to 
render  it  more  palatable.  It  also  serves  to  kill  any  para- 
sites present,  and  thus  prevents  infection. 

Of  the  different  methods  of  cooking  meat,  broiling  and 
roasting  are  the  best,  as  in  these  methods  the  juices  of 
the  meat  are  retained  as  much  as  possible.  In  boiling 
and  stewing  a  considerable  portion  of  the  juices  are  ex- 
tracted. Frying  in  oil  renders  the  meat  richer  in  fats 
and  therefore  more  difficult  to  digest  than  when  roasted 
or  broiled. 

Effect  of  Light  and  Dark  Meats — During  the  last  few 
years  there  has  been  considerable  discussion  as  to  the 
influence  of  dark  meats,  especially  in  cases  of  chronic 
parenchymatous  nephritis,  and  in  diseases  of  the  nervous 
system.  This  differentiation  between  light  and  dark 
meats  has  been  traced  back  to  the  time  of  Sydenham, 
who  allowed  his  neurasthenic  patients  the  light  meat  of 
calves,  chickens,  and  fish,  but  prohibited  the  use  of  beef, 
because  it  favored  the  production  of  nervous  disease. 
Later  it  was  prohibited  because  it  was  believed  to  favor 
the  production  of  uric  acid.  In  consequence  of  this  fact 
the  differentiation  between  light  and  dark  meats  began 
to  play  an  important  role  in  the  treatment  of  diseases  of 
the  kidneys.  In  recent  times  stomach  and  intestinal 
diseases,  acute  and  chronic  rheumatism,  and  the  func- 
tional neuroses  are  also  believed  to  be  influenced  unfav- 
orably by  the  use  of  the  dark  meats. 

In  the  treatment  of  kidney  diseases  the  prohibition  of 
dark  meats  is  based  upon  the  fact  that  these  meats  con- 
tain a  greater  proportion  of  nitrogenous  extractives,  and 
that  these  extractives  produce  irritation  of  the  kidneys 
when  eliminated,  or  in  deficient  action  of  the  kidneys 
they  accumulate  in  the  system  and  produce  toxic  effects. 
The  nitrogenous  extractives  of  meat  to  which  this  effect 
is  traced  are,  more  especially,  the  creatin  and  creatinin, 
xanthin,  leucin  and  tyrosin,  and  ptomains,  besides  other 
extractives.      Smoked  and  pickled  meats  contain  other 


204  FOOD  AND  DIETING. 

irritating   products,    besides    those    contained    in    fresh 
meat,  and  are  therefore  far  more  injurious. 

The  trend  of  opinion  at  the  present  time  is  to  minimize 
the  differentiation.  Pabst  was  unable  to  determine  any- 
appreciable  difference  in  the  amount  of  urine  excreted, 
and  the  proportion  of  albumin  eliminated,  with  a  milk 
diet,  a  diet  of  dark  meat,  white  meat,  or  a  mixed  diet. 

Lean  beef  is  composed  of  about  76  per  cent,  of  water, 
21.5  per  cent,  of  nitrogenous  substances,  1.5  per  cent,  of 
fat,  and  1  per  cent,  of  salts.  The  composition  varies, 
however,  in  the  same  animal  according  to  the  part  from 
which  it  is  taken,  for  instance:  The  neck  contains  73.5 
per  cent,  of  water,  19.5  per  cent,  of  nitrogenous  sub- 
stances, 5.8  per  cent,  of  fat,  and  1.2  per  cent,  of  salts; 
the  flank,  63.4  per  cent  of  water,  18.8  per  cent,  of  nitro- 
genous substances,  16.7  per  cent,  of  fat,  and  1.1  per  cent. 
of  salts;  the  shoulder,  50.5  per  cent  of  water,  14.5  per 
cent,  of  nitrogenous  substances,  34  per  cent,  of  fat,  and 
1  per  cent,  of  salts.  With  increase  in  fat  the  percentage 
of  water  decreases;  the  percentage  of  nitrogenous  sub- 
stance is,  however,  increased  very  little  by  the  fattening 
process.  The  percentage  of  water  is  also  greater  in  the 
flesh  of  young  animals  than  in  that  of  adult  animals. 

Veal — Veal  is  usually  more  difficult  of  digestion  than 
beef.  Konig  attributes  this  to  the  fact  that  it  is  more 
tender  and  therefore  less  resistant  to  the  masticating 
process,  and  is,  consequently,  masticated  with  more  diffi- 
culty than  other  meat.  It  contains  a  greater  proportion 
of  water  than  beef.  Its  nutritive  value  is  dependent 
upon  the  age  of  the  calf  when  slaughtered,  the  younger 
it  is  the  more  watery  the  flesh,  and  the  lower  the  propor- 
tion of  nutritive  substances.  In  some  countries,  as  in 
the  United  States  and  Austria,  veal  is  not  permitted  to 
be  used  for  food  under  one  month  of  age. 

Mutton — The  flesh  of  sheep  and  lambs  is  composed  of 
finer  muscular  bundles  than  beef,  and  is,  in  general, 
easily  digested. 

Pork — The  nature  of  the  food-supply  influences  the 


MILK  AND  MILK-PRODUCTS. 


205 


character  of  the  flesh  of  pigs  to  an  important  extent, 
especially  with  regard  to  its  flavor  and  the  deposition  of 
the  fat.  Pork  is  more  difficult  of  digestion  than  the  meat 
of  any  of  the  other  domestic  animals. 

Poultry  and  Game — The  flesh  of  birds  differs  from 
that  of  mammals  in  the  fact  that  the  fat  is  deposited  in 
the  muscular  tissue  to  only  a  limited  extent.  It  is  also 
of  a  more  delicate  flavor  than  that  of  mammals.  It  is 
easier  to  digest  than  the  flesh  of  mammals  and  is  there- 
fore frequently  recommended  for  invalids. 

Fish. — The  flesh  of  most  fish  is  white  because  their 
blood  is  white,  though  some  have  red  blood.  It  is  rich 
in  water,  and  varies  in  its  fat  content,  both  quantitatively 
and  qualitatively.  The  flavor  of  the  flesh  is  dependent 
upon  the  different  character  of  the  fat  in  different  fish. 
The  structure  of  the  flesh  is  similar  to  that  of  mammals, 
and  is  equally  nutritious.  According  to  the  investiga- 
tions of  Atwater,  the  flesh  of  fish  is  as  readily  digestible 
as  beef.     There  are,  however,  individual  differences. 

Relative  Composition  of  Different  Kinds  of  Meat  (Konig). 


Ox,  fat 

Calf,  fat  (9  analyses)  . 
Lamb,  fat  (9  analyses) 
Pork,  fat  (5  analyses)  . 
Horse  (12  analyses).    . 

Chicken,  fat 

Duck,  wild 

Goose,  fat 

Herring:  (2  analyses)  . 
Trout  (8  analyses)     .    . 


Per 
cent. 

45-5 

72-3i 

53-31 

47.40 

74.27 

76.22 

70.82 

38.02 

74.64 

79-63 


be  2 


Per 

cent. 


16.82 
14.54 
21.71 
18.48 
22.65 
I5-91 
14-55 
18.42 


Per 

cent. 

30-J7 
7.41 

28.61 

37-34 
2-55 
9-34 
3" 

45-59 
9-°3 
o.53 


J)   v 

be  > 
o  • - 

a  t> 


Per 

cent. 


Per 
cent. 

3-9 

i-33 
93 
72 
01 

91 
09 


In  dry  substance. 


Per 
cent. 


61.76 

77-59 
38.02 
56.42 
9°-59 


Per 

cent. 


26.04 
61.28 


73-55 

35-85 

2.42 


Per 

cent. 


11.02 
5-7o 
4-5o 

i3-7l 
9.88 

12.92 
4.11 

9-°3 
14.50 


Milk  and  Milk-products. — Milk. — Cows'  milk  forms 
a  most  important  article  of  diet  in  the  United  States.  It 
is  of  the  greatest  importance,  therefore,  that  the  milk 
placed  on  the  market  should  be  as  pure  and  wholesome 
as   possible.     The    fact   that   milk   is  such   a   favorable 


206  FOOD  AND  DIETING. 

culture-medium  for  most  classes  of  bacteria  makes  it 
possible  for  milk  to  become  the  carrier  of  disease.  It 
may  also  be  dangerous  because  of  the  presence  of  disease- 
producing  bacteria  derived  from  the  cow,  or  because  of 
the  presence  and  growth  of  non-pathogenic  forms.  If 
the  milk  could  be  collected  and  stored  in  such  a  manner 
as  to  prevent  the  entrance  of  bacteria,  it  would  keep  a 
long  time;  but  this  is  impossible,  because  it  is  frequently 
contaminated  with  bacteria  in  the  milk-ducts  of  the 
udder.  It  is  also  further  contaminated  with  bacteria 
derived  from  the  fur  and  udder  of  the  cow,  the  hands  of 
the  milker,  the  air  of  the  stable  and  milk-house,  and  the 
utensils  in  which  it  is  collected  and  stored. 

Some  of  these  bacteria,  as  the  lactic  acid  group,  fer- 
ment the  lactose  and  produce  lactic  acid,  causing  the 
milk  to  turn  sour  and  the  casein  to  coagulate.  Other 
classes  of  bacteria  cause  the  milk  to  decompose,  with  the 
production  of  bad  odors;  these  are  the  putrefactive  organ- 
isms. It  has  been  found  that  storing  the  milk  in  an  ice 
chest  for  several  days  inhibits  the  multiplication  of  the 
lactic  acid  group  of  bacteria  but  does  not  inhibit  the 
multiplication  of  the  putrefactive  bacteria,  so  that  the 
milk  under  these  conditions  becomes  putrid  before  it 
turns  sour. 

Pure  and  wholesome  milk  can  only  be  produced  from 
healthy  cows,  but  the  milk  of  healthy  cows  may  soon  be 
rendered  useless  through  carelessness  in  collecting  and 
storing.  The  precautions  necessary  for  the  production 
of  pure  and  wholesome  milk  are,  therefore,  far-reaching, 
numerous,  and  exacting.  These  precautionary  measures 
should  include  the  selection  of  healthy  cows;  their  treat- 
ment and  housing  should  be  such  as  to  favor  the  mainte- 
nance of  their  health;  the  utmost  cleanliness  about  the 
stables  and  milk-house;  the  cleanliness  of  the  milker 
and  of  those  who  handle  and  market  the  milk;  the 
utmost  cleanliness  of  all  utensils  employed  in  collecting, 
storing,  and  marketing  milk. 

Diseases  Conveyed  through  Milk. — A  number  of  dis- 


MILK  AND  MILK-PRODUCTS.  207 

eases  may  be  conveyed  through  milk,  and  they  may  be 
derived  either  from  the  cow  yielding  the  milk  or  from 
those  who  come  in  contact  with  the  milk  in  collecting 
and  marketing  it.  The  diseases  that  may  be  conveyed 
directly  from  the  cow  are  tuberculosis  and  micro-organ- 
isms of  inflammatory  diseases,  such  as  the  Streptococcus 
and  Staphylococcus  pyogenes. 

While  the  positive  conveyance  of  tuberculosis  from 
the  domestic  animals  to  man  is  still  disputed  by  some, 
especially  that  of  bovine  tuberculosis  through  the  use  of 
the  milk  and  meat  of  tubercular  animals,  because  of 
slight  morphologic  and  biologic  differences  between  the 
bacillus  as  found  in  bovine  and  human  tuberculosis,  the 
trend  of  opinion  to-day  is  in  favor  of  regarding  the  milk 
of  all  tubercular  animals  as  dangerous  to  health.  The 
direct  transmission  of  bovine  tuberculosis  to  members  of 
the  human  family  is  infrequently  demonstrated,  because 
of  the  insidious  onset  of  the  disease  and  its  slow  progress; 
yet  there  are  some  cases  on  record  which  appear  beyond 
a  doubt  to  have  been  contracted  in  this  manner.  Leon- 
hart  reports  the  case  of  a  healthy  infant,  of  healthy  par- 
ents, which  was  weaned  and  put  on  cows'  milk.  The 
child  soon  died  of  tuberculosis  of  the  meninges,  intes- 
tines, and  mesenteric  glands.  The  cow  from  which  the 
milk  was  derived  was  found  to  be  tuberculous.  Another 
child  fed  on  the  milk  of  the  same  cow  died,  at  about  the 
same  time,  from  tubercular  meningitis.  Sonntag  reports 
the  case  of  a  six  months'  old  infant,  of  healthy  parents, 
which  at  autopsy  showed  miliary  tuberculosis  of  the 
meninges.  It  was  fed  on  milk  derived  from  a  tubercular 
cow.  Hermsdorf  gives  3  instances  in  which  there  was 
extensive  intestinal  tuberculosis,  besides  general  affection 
of  other  organs.  One  had  taken  uncooked  milk  from  a 
tubercular  cow.  Demme  reports  the  case  of  a  four 
months'  old  infant  which  at  autopsy  showed  tuberculosis 
of  the  mesenteric  glands.  There  was  no  tuberculosis  in 
the  family  for  two  generations  on  either  side.  The  milk 
came  from  a  cow  with  general   tuberculosis.     Bollinger 


2o8  FOOD  AND  DIETING. 

cites  Stang's  case  of  a  boy  of  five  years,  who  sickened 
with  ascites  and  enlarged  glands  in  the  abdomen.  At 
autopsy  the  chief  lesion  was  tuberculosis  of  the  abdomi- 
nal lymphatics,  but  there  was  also  tuberculosis  of  the 
serous  membranes  and  of  the  lungs.  There  was  no 
tuberculosis  in  the  family  for  two  generations.  The  child 
had  for  years  been  in  the  habit  of  drinking  milk  warm 
from  a  cow,  which,  growing  thin  before  the  boy  died, 
was  killed,  and  found  to  be  tubercular. 

Holt  reports  on  1045  consecutive  autopsies  from  the 
records  of  the  New  York  Infant  Asylum  and  Babies' 
Hospital — 10  per  cent,  of  which  were  found  to  be  tuber- 
culous. In  the  latter  institution,  which  receives  only 
sick  children,  the  percentage  was  higher.  Of  143  children, 
57  were  less  than  one  year  of  age;  39  between  one  and 
two  years;  20  between  two  and  five  years;  and  only  15 
over  five  years  of  age. 

To  guard  against  the  dangers  of  infection  through  the 
use  of  milk  from  tubercular  cows,  the  thorough  inspec- 
tion of  all  cows  kept  for  breeding-purposes,  or  whose 
milk  is  offered  for  general  consumption,  should  be  in- 
sisted upon.  The  most  reliable  and  ready  method  known 
to-day,  by  means  of  which  we  can  detect  the  disease  even 
in  its  incipient  stage,  is  the  tuberculin-test.  This  test  is 
now  employed  in  many  States  and  in  many  foreign 
countries,  and,  if  the  tuberculin  has  been  prepared  by 
competent  bacteriologists,  it  is  believed  to  be  without 
detrimental  effects  on  healthy  animals. 

Among  the  laws  enacted  to  arrest  the  spread  of  tuber- 
culosis among  cattle,  and  from  cattle  to  man,  may  be 
mentioned  the  tuberculin  law  of  Denmark,  of  1893, 
which  makes  regulations  for  the  exclusion  from  commerce 
of  all  animals  apparently  tubercular,  as  well  as  for  the 
pasturing  of  such  animals  together  with  others.  It  also 
forbids  the  use  of  uninspected  meat  of  such  animals,  and 
also  the  use  of  milk  from  cows  suffering  from  tuberculo- 
sis of  the  udder.  In  this  country  several  States  have 
passed  laws  creating  sanitary  commissions  for  the  inspec- 


MILK  AND  MILK-PRODUCTS.  209 

tion  and  slaughtering  of  diseased  animals  upon  the 
voluntary  request  of  the  dairymen.  The  Act  of  May  21, 
1895,  establishing  the  State  Live  Stock  Sanitary  Board 
of  Pennsylvania,  is  a  law  of  this  nature.  The  law  of 
April  26,  1895,  enacted  by  the  legislature  of  Minnesota, 
will  no  doubt  have  more  salutary  effects,  and  seems  to  be 
more  directly  in  the  line  of  future  action.  This  law 
directs  that  the  city  council  of  any  city  may,  by  ordi- 
nance, provide  for  the  inspection  of  milk  dairies  and  of 
dairy  herds  kept  for  the  production  of  milk  within  its 
limits,  and  issue  licenses,  for  which  no  fee  shall  be 
charged,  for  the  sale  of  milk  within  its  limits,  and 
regulate  the  same,  and  may  authorize  and  empower  the 
board  of  health  to  enforce  all  laws  and  ordinances  relat- 
ing to  the  production  and  sale  of  milk,  and  the  inspection 
of  dairies  and  dairy  herds  producing  milk  for  sale  or  con- 
sumption within  such  city,  and  to  appoint  such  in- 
spectors, experts,  and  chemists  as  are  necessary  for  the 
proper  enforcement  of  such  laws  and  ordinances.  Under 
this  law  the  city  council  of  Minneapolis  passed,  June  14, 
1895,  and  approved  June  21,  1895,  an  ordinance  embody- 
ing all  the  features  contained  in  the  State  law.  The  city 
of  Port  Huron,  Michigan,  also  adopted  a  milk  ordi- 
nance, September  26,  1896,  to  regulate  and  control  the 
sale  of  milk  in  the  city,  in  which  the  licensing  of  all 
milk-dealers,  and  the  inspection  of  all  dairy  herds  and 
dairies  is  required. 

In  New  York  City  an  ordinance  was  passed,  in  1895, 
forbidding  the  sale  of  milk  within  the  city  without  a 
permit  from  the  department  of  health,  and  requiring  that 
all  wagons  used  for  the  transportation  or  delivery  of 
milk  should  likewise  have  wagon  permits.  Before  these 
permits  are  issued  the  holder  must  furnish  information 
as  to  the  source  from  which  the  milk  is  obtained,  the 
number  of  animals,  the  character  of  the  food-supply, 
and  the  sanitary  conditions  surrounding  the  dairy.  All 
milk  cows  in  the  city  have  been  subjected  to  the  tuber- 
culin-test, under  the  supervision  of  the  health  depart- 
u 


210  FOOD  AND  DIETING. 

rnent,  and  the  diseased  animals  killed.  It  is  also  proposed 
to  require  similar  tests  to  be  applied  to  all  cows  whose 
milk  is  sent  to  the  city. 

Influence  of  Food=supply  on  the  Milk. — In  cows  fed  on 
distillery  grains,  as  well  as  in  stall-fed  cows,  it  is  not 
unusual  to  find  a  considerable  proportion  of  them  suffer- 
ing from  garget,  an  inflammatory  condition  of  the  milk- 
ducts.  Dr.  Stokes,  of  Baltimore,  has  done  considerable 
work  on  this  subject,  and  has  made  a  careful  study  of  the 
milk  of  three  classes  of  dairies,  viz. :  No.  i,  consisting 
of  ioo  cows  in  the  country,  kept  in  a  well-ventilated 
stable  with  good,  roomy  stalls,  and  good  pasturage. 
They  were  fed  while  in  the  stable  on  bran,  ground  corn, 
and  hay.  The  cows  were  curried  and  cleaned  daily. 
The  herds  were  inspected  by  competent  veterinary  sur- 
geons, and  all  sick  animals  isolated.  The  usual  pre- 
cautions regarding  cleanly  milking  were  observed. 

No.  2,  consisting  of  50  cows  in  the  country  having 
badly  ventilated  stables,  narrow  stalls,  and  bad  pasturage. 
They  were  fed  on  distillery  grains,  cut  hay,  and  bran,  the 
precautions  with  regard  to  inspection  and  cleanly  milking 
were  not  observed. 

No.  3,  consisting  of  100  cows  kept  in  the  city,  always 
confined  to  stables,  with  narrow  stalls,  poor  ventilation 
and  light,  and  no  pasturage.  They  were  fed  on  brewery 
grain,  distillery  slops,  bran,  and  hay.  The  cows,  as  a 
rule,  never  left  the  stable  until  they  went  dry  or  were 
taken  out  to  be  exchanged. 

The  influence  of  the  food  and  surroundings  on  the 
healthfulness  of  the  milk  is  shown  in  the  following 
results:  93  cows  out  of  100  in  grade  No.  1  gave  less  than 
5  pus-cells  to  the  microscopic  field,  while  in  grade  No.  3, 
38  gave  this  average;  98  cows  out  of  100  in  grade  No.  1 
gave  less  than  10  pus-cells  per  microscopic  field,  while 
in  grade  No.  3,  54  out  of  100  showed  this  number. 
Grade  No.  1  gave  an  average  of  1.1  pus-cells  to  the 
field;  No.  2  gave  an  average  of  11.3;  while  No.  3  showed 
19. 2  pus-cells  per  microscopic  field. 


MILK  AND  MILK-PRODUCTS.  211 

Recently,  Beck,  of  Berlin,  reported  on  an  investiga- 
tion of  56  samples  of  market  milk  as  to  the  presence  of 
pathogenic  bacteria  in  such  milk.  He  found  tubercle 
bacilli  in  30.3  per  cent,  of  the  samples,  and  streptococci 
in  62.3  per  cent.  These  streptococci  were  pathogenic 
for  guinea-pigs  when  injected  intraperitoneally,  the  ani- 
mals dying  in  from  three  to  four  days  from  a  purulent 
peritonitis.  The  peritoneal  exudate  usually  contained 
the  streptococci  in  pure  cultures.  Mice  were  killed  in 
about  twenty-four  hours  by  subcutaneous  and  intraperi- 
toneal injections  of  small  amounts  of  a  bouillon  culture 
of  the  streptococci,  with  symptoms  of  general  infection. 
Rabbits  died  in  two  or  three  days  after  intravenous  injec- 
tions of  a  few  drops  of  a  bouillon  culture;  in  some  in- 
stances serous,  purulent  exudates  into  the  joints  were 
observed.  A  fresh  culture  rubbed  into  the  skin  of  the 
rabbit's  ear  was  productive  of  an  erysipelatous  inflamma- 
tion of  the  entire  ear,  with  considerable  fever,  though  all 
of '  these  animals  recovered.  The  injection  of  1  to  3.5 
cubic  centimeters  of  a  fresh  bouillon  culture  into  the 
stomach  of  guinea-pigs  resulted  in  the  production  of 
severe  diarrhea,  some  of  the  animals  dying  of  enteritis. 
On  post-mortem  examination  of  these  animals  the  mucous 
membrane  of  the  intestine  was  found  to  be  markedly  red- 
dened, showing  ecchymoses,  and  the  fluid  contents  of  the 
intestine  contained  numerous  streptococci. 

Beck  believes  these  streptococci  to  be  closely  related 
to  those  found  by  Escherich  in  the  enteritis  of  infants. 
He  states  that  Romme  also  believes  in  the  danger  of 
infantile  enteritis  from  these  streptococci. 

The  use  of  milk  derived  from  cows  suffering  from  in- 
flammatory  disease  of  the  milk-ducts  is  undoubtedly  pro- 
ductive of  inflammatory  conditions  of  the  gastrointesti- 
nal tract,  especially  in  infants.  The  cases  of  fatal  strep- 
tococcus enteritis  reported  by  Hirsch  and  Ljbbert  appear 
to  have  been  cases  of  this  kind.  Booker  is  also  of  the 
opinion  that  gastro-enteritis  is  not  infrequently  produced 
in  this  manner. 


212  FOOD  AND  DIETING. 

Of  the  diseases  conveyed  in  milk,  aside  from  those 
derived  from  the  cows  themselves,  may  be  mentioned 
typhoid  fever,  cholera,  diphtheria,  and  scarlet  fever. 
These  diseases  are  not  produced  by  infection  derived 
from  the  cows,  but  by  contamination  of  the  milk  with 
polluted  water,  or  by  means  of  flies,  and  by  means  of 
infected  hands  and  clothing  of  the  milkers  or  those  em- 
ployed in  collecting  and  marketing  the  milk. 

Typhoid  fever  and  cholera  may  be  conveyed  through 
milk  in  very  much  the  same  manner.  These  diseases 
are  most  frequently  conveyed  through  impure  drinking- 
water,  but  when  the  milking  utensils  are  washed  in  pol- 
luted water,  or  the  milk  is  diluted  with  water  containing 
the  typhoid  and  cholera  organisms,  the  diseases  may  be 
conveyed  in  this  manner.  Again,  flies  and  other  insects 
are  no  doubt  frequently  concerned  in  conveying  these 
diseases  by  coming  in  contact  with  the  fresh  evacuations 
of  patients  suffering  therefrom,  and  then  subsequently 
infecting  milk.  For  these  reasons  the  storing  of  milk  in 
such  a  manner  as  to  prevent  the  possibility  of  this  mode 
of  infection  is  of  the  greatest  importance. 

Diphtheria  and  scarlet  fever  may  be  conveyed  in  milk; 
and  a  number  of  epidemics  of  these  diseases  have  been 
traced  to  their  source  in  contaminated  milk.  The  most 
common  mode  of  contamination  is  through  the  infected 
hands  of  milkers  and  those  handling  the  milk.  The 
most  rigid  care  should  be  exercised  to  avoid  the  dissemi- 
nation of  these  diseases  iu  this  manner.  No  one  suffer- 
ing from  these  diseases,  nor  any  one  coming  in  contact 
with  those  suffering  from  them,  should  be  allowed  to 
milk  or  handle  any  milk  that  is  intended  for  general 
consumption.  There  is  no  evidence  at  hand  to  substan- 
tiate the  belief  that  cattle  suffer  from  either  of  these  dis- 
eases. The  milk  is  usually  contaminated  by  the  family 
of  the  dairyman,  or  others  through  whose  hands  the 
milk  passes  on  its  way  to  the  consumer. 

Municipal  Control  of  the  Milk-supply. — In  order  to 
make  it  possible  for  the  poorer  classes  to  obtain  a  milk- 


MILK  AND  MILK-PROD UCTS.  2 1 3 

supply  that  is  free  from  danger,  it  is  necessary  for  munici- 
palities to  institute  certain  regulations  to  control  the 
marketing  of  milk.  This  is  especially  necessary  on 
account  of  the  relation  of  the  milk-supply  to  the  high 
infantile  mortality.  There  should  be  direct  supervision 
of  the  dairies  and  their  surroundings.  This  should 
include  an  investigation  and  repeated  inspection  of  the 
health  of  the  herd,  the  nature  of  their  food-supply,  the 
purity  of  the  water  on  the  farm,  and  the  general  sanitary 
conditions  on  the  farm.  All  the  milk-dealers  in  the  city 
should  be  licensed,  and  their  wagons  distinctly  marked 
so  as  to  indicate  the  name  of  the  dealer  and  the  source 
of  the  milk.  Especial  importance  should  be  attached  to 
the  sale  of  milk  in  stores  and  the  sanitary  precautions 
required  in  storing  milk.  The  use  of  all  preservatives 
must  be  strictly  prohibited  on  account  of  their  detri- 
mental influence  on  health. 

FIFTY  DAIRY  RULES.1 

The  Owner  and  His  Helpers. — 1.  Read  current  dairy 
literature  and  keep  posted  on  new  ideas. 

2.  Observe  and  enforce  the  utmost  cleanliness  about 
the  cattle,  their  attendants,  the  stable,  the  dairy,  and  all 
utensils. 

3.  A  person  suffering  from  any  disease,  or  who  has 
been  exposed  to  a  contagious  disease,  must  remain  away 
from  the  cows  and  the  milk. 

The  Stable. — 4.  Keep  dairy  cattle  in  a  room  or  build- 
ing by  themselves.  It  is  preferable  to  have  no  cellar 
below  and  no  storage  loft  above. 

5.  Stables  should  be  well  ventilated,  lighted,  and 
drained;  should  have  tight  floors  and  walls,  and  be 
plainly  constructed. 

6.  Never  use  musty  or  dirty  litter. 

7.  Allow  no  strongly  smelling  material  in  the  stable 
for  any  length  of  time.     Store  the  manure  under  cover 

1  Report  of  the  Bureau  of  Animal  Industry,  1898. 


214  FOOD  AND  DIETING. 

outside  the  cow  stable,  and  remove  it   to  a  distance  as 
often  as  practicable. 

8.  Whitewash  the  stable  once  or  twice  a  year.  Use 
land  plaster  in  the  manure  gutters  daily. 

9.  Use  no  dry,  dusty  feed  just  previous  to  milking;  if 
fodder  is  dusty,  sprinkle  it  before  it  is  fed. 

10.  Clean  and  thoroughly  air  the  stable  before  milking. 
In  hot  weather  sprinkle  the  floor. 

11.  Keep  the  stable  and  dairy-room  in  good  condition, 
and  then  insist  that  the  dairy,  factory,  or  place  where  the 
milk  goes  be  kept  equally  well. 

The  Cows. — 12.  Have  the  herd  examined  at  least  twice 
a  year  by  a  skilled  veterinarian. 

13.  Promptly  remove  from  the  herd  any  animal  sus- 
pected of  being  in  bad  health  and  reject  her  milk.  Never 
add  an  animal  to  the  herd  until  certain  it  is  free  from 
disease,  especially  tuberculosis. 

14.  Do  not  move  cows  faster  than  a  comfortable  walk 
while  on  the  way  to  place  of  milking  or  feeding. 

15.  Never  allow  the  cows  to  be  excited  by  hard  driving, 
abuse,  loud  talking,  or  unnecessary  disturbance;  do  not 
expose  them  to  cold  or  storm. 

16.  Do  not  change  the  feed  suddenly. 

17.  Feed  liberally,  and  use  only  fresh,  palatable  feed- 
stuffs;  in  no  case  should  decomposed  or  mouldy  material 
be  used. 

18.  Provide  water  in  abundance,  easy  of  access,  and 
always  pure;  fresh,  but  not  too  cold. 

19.  Salt  should  always  be  accessible. 

20.  Do  not  allow  any  strong-flavored  food,  like  garlic, 
cabbage,  and  turnips  to  be  eaten,  except  immediately 
after  milking. 

21.  Clean  the  entire  body  of  the  cow  daily.  If  the  hair 
in  the  region  of  the  udder  is  not  easily  kept  clean,  it 
should  be  clipped. 

22.  Do  not  use  the  milk  within  twenty  days  before 
calving,  nor  within  three  to  five  days  afterward. 

Milking. — 23.   The    milker    should    be    clean    in    all 


MILK  AND  MILK-PRODUCTS.  215 

respects;  he  should  not  use  tobacco;  he  should  wash  and 
dry  his  hands  just  before  milking. 

24.  The  milker  should  wear  a  clean  outer  garment; 
used  only  when  milking,  and  kept  in  a  clean  place  at 
other  times. 

25.  Brush  the  udder  and  surrounding  parts  just  before 
milking,  and  wipe  them  with  a  clean,  damp  cloth  or 
sponge. 

26.  Milk  quietly,  quickly,  cleanly,  and  thoroughly. 
Cows  do  not  like  unnecessary  noise  or  delay.  Commence 
milking  at  exactly  the  same  hour  every  morning  and 
evening,  and  milk  the  cows  in  the  same  order. 

27.  Throw  away  (but  not  on  floor,  better  in  the  gutter) 
the  first  few  streams  from  each  teat;  this  milk  is  very 
watery  and  of  little  value,  and  it  may  injure  the  rest. 

28.  If  in  any  milking  a  part  of  the  milk  is  bloody  or 
stringy  or  unnatural  in  appearance,  the  whole  mess 
should  be  rejected. 

29.  Milk  with  dry  hands;  never  allow  the  hands  to 
come  in  contact  with  the  milk. 

30.  Do  not  allow  dogs,  cats,  or  loafers  to  be  around  at 
milking-time. 

31.  If  any  accident  occurs  by  which  a  pail  full  or 
partly  full  of  milk  becomes  dirty,  do  not  try  to  remedy 
this  by  straining,  but  reject  all  this  milk  and  rinse  the 
pail. 

32.  Weigh  and  record  the  milk  given  by  each  cow, 
and  take  a  sample  morning  and  night,  at  least  once  a 
week,  for  testing  by  the  fat-test. 

Care  of  Milk. — 33.  Remove  the  milk  of  every  cow  at 
once  from  the  stable  to  a  clean,  dry  room,  where  the  air 
is  pure  and  sweet.  Do  not  allow  cans  to  remain  in 
stables  while  they  are  being  filled. 

34.  Strain  the  milk  through  a  metal  gauze  and  a  flan- 
nel cloth  or  layer  of  cotton  as  soon  as  it  is  drawn. 

35.  Aerate  and  cool  the  milk  as  soon  as  strained.  If 
an  apparatus  for  airing  and  cooling  at  the  same  time  is 
not  at  hand,  the  milk  should  be  aired  first.     This  must 


2i6  FOOD  AND  DIETING. 

be  done  in  pure  air,  and  it  should  then  be  cooled  to 
450  F.  if  the  milk  is  for  shipment,  or  to  6o°  F.  if  for 
home  use  or  delivery  to  a  factory. 

36.  Never  close  'a  can  containing  warm  milk  which 
has  not  been  aerated. 

37.  If  cover  is  left  off  the  can,  a  piece  of  cloth  or  mos- 
quito-netting should  be  used  to  keep  out  insects. 

38.  If  milk  is  stored,  it  should  be  held  in  tanks  of 
fresh,  cold  water  (renewed  daily),  in  a  clean,  dry,  cold 
room.  Unless  it  is  desired  to  remove  cream,  it  should  be 
stirred  with  a  tin  stirrer  often  enough  to  prevent  forming 
a  thick  cream  layer. 

39.  Keep  the  night  milk  under  shelter  so  that  rain 
cannot  get  into  the  cans.  In  warm  weather  hold  it  in  a 
tank  of  fresh  cold  water. 

40.  Never  mix  fresh  warm  milk  with  that  which  has 
been  cooled. 

41.  Do  not  allow  the  milk  to  freeze. 

42.  Under  no  circumstances  should  anything  be  added 
to  milk  to  prevent  its  souring.  Cleanliness  and  cold  are 
the  only  preventatives  needed. 

43.  All  milk  should  be  in  good  condition  when  de- 
livered. This  may  make  it  necessary  to  deliver  twice  a 
day  during  the  hottest  weather. 

44.  When  cans  are  hauled  far  they  should  be  full,  and 
carried  in  a  spring  wagon. 

45.  In  hot  weather  cover  the  cans,  when  moved  in  a 
wagon,  with  a  clean  wet  blanket  or  canvas. 

The  Utensils. — 46.  Milk  utensils  for  farm  use  should 
be  made  of  metal,  and  have  all  joints  smoothly  soldered. 
Never  allow  utensils  to  become  rusty  or  rough  inside. 

47.  Do  not  haul  waste  products  back  to  the  farm  in 
the  cans  used  for  delivering  milk.  When  this  is 
unavoidable,  insist  that  the  skimmed  milk  or  whey  can 
be  kept  clean. 

48.  Cans  used  for  the  return  of  skimmed  milk  or  whey 
should  be  emptied  and  cleaned  as  soon  as  they  arrive  at 
the  farm. 


MILK  AND  MILK-PRODUCTS.  217 

49.  Clean  all  dairy  utensils  by  first  thoroughly  rinsing 
them  in  warm  water;  then  clean  inside  and  out  with  a 
brush  and  hot  water  in  which  a  cleaning  material  is 
dissolved;  then  rinse,  and  lastly  sterilize  by  boiling  water 
or  steam.     Use  pure  water  only. 

50.  After  cleansing,  keep  utensils  inverted,  in  pure 
air,  and  sun  if  possible,  until  wanted  for  use. 

Butter. — Butter  serves  as  an  important  source  of  fat  in 
the  food  of  most  people.  It  is  very  palatable  to  most 
persons,  and  it  is  easily  digested  when  fresh  and  pure. 
When  kept  for  some  time  butter  becomes  rancid — that  is, 
the  fat  becomes  changed  through  the  action  of  bacteria 
contained  in  the  butter,  and  in  this  condition  it  is  more 
difficult  to  digest. 

Butter  may  be  dangerous  to  health  in  two  ways  :  It 
may  contain  the  specific  micro-organisms  of  certain  dis- 
eases, as  the  typhoid  bacillus  or  the  Bacillus  tuberculosis, 
or  it  may  be  adulterated  with  other  fatty  substances, 
animal  or  vegetable.  The  typhoid  bacillus  may  be  pres- 
ent in  butter  through  the  use  of  polluted  water  in  wash- 
ing the  utensils  used  in  the  collection  and  storing  of  the 
milk,  or  in  making  the  butter.  The  Bacillus  tubercu- 
losis may  be  present  from  the  cows  from  which  the  milk 
is  derived.  Virulent  tubercle  bacilli  have  been  found  a 
number  of  times  in  butter  made  from  the  milk  of  tuber- 
cular cows. 

The  addition  of  other  fatty  substances  to  butter,  or  the 
substitution  of  these  fats  for  butter,  under  the  names  of 
butterin  and  oleomargarin,  is  now  prohibited  by  law, 
though  it  is  by  no  means  infrequent  even  at  the  present 
time.  These  fats  are  usually  more  difficult  of  digestion, 
aside  from  the  fact  that  they  are  fraudulent  substitutes 
for  a  healthy  article  of  diet. 

Cheese — The  high  nutritive  value  of  cheese,  and  its 
cheapness,  make  it  an  important  article  of  food,  espe- 
cially for  the  poorer  classes. 

Cheese  may  be  injurious  to  health  on  account  of  the 
presence  of  tubercle  bacilli  when  the  milk   is  derived 


218  FOOD  AND  DIETING. 

from  tubercular  cows,  though  it  is  claimed  these  organ- 
isms cannot  live  in  cheese  for  more  than  fourteen  days. 
The  typhoid  bacillus  and  cholera  organism  die  after  a 
very  few  days.  Cheese  may  also  be  injurious  to  health 
because  of  the  presence  of  poisonous  products  of  non- 
pathogenic bacteria  of  certain  species.  This  poisonous 
substance  is  of  the  nature  of  a  ptomain.  It  has  been 
extensively  studied  by  Vaughan,  who  has  called  it  tyro- 
toxicon.  This  form  of  poisoning  by  cheese  is  not  infre- 
quent. It  may  also  occur  in  iced  cream,  and  in  milk 
under  certain  circumstances.  It  is  accompanied  by 
grave  gastro-intestinal  disturbances  and  marked  nervous 
depression. 

Vegetable  Foods. — The  vegetable  foods  exceed  in 
number  and  form  those  derived  from  the  animal  king- 
dom. They  differ  from  the  animal  foods  principally  in 
the  form  in  which  the  nutritive  substances  (nitrogenous 
matter  and  fat)  occur,  and  in  the  presence  of  starch,  gums, 
sugars,  and  other  nitrogen-free  extractives  which  do  not 
occur  in  animal  foods.  These  latter  substances  con- 
tained in  vegetable  foods  take  the  place,  in  part,  of  the 
fats  in  animal  foods.  The  various  forms  of  sugar  found 
in  vegetable  foods,  as  glucose,  saccharose,  mannose,  etc., 
take  the  place  of  the  lactose  and  inosit  of  animal  foods. 
Another  nitrogen-free  substance  present  in  vegetable 
foods  which  is  not  found  in  animal  foods  is  cellulose, 
which  is  partly  digested,  and  in  part  serves  other  useful 
purposes  in  foods. 

The  nitrogenous  substances  contained  in  vegetable 
foods  are  vegetable  albumin  and  casein,  gluten,  nuclein, 
besides  other  nitrogenous  substances,  as  asparagin,  leu- 
cin,  amygdalin,  allantoin,  lecithin,  etc. 

The  mineral  substances  contained  in  vegetable  foods 
are  qualitatively  the  same  as  those  contained  in  animal 
foods. 


VEGETABLE  FOODS. 


219 


Composition  of  the  Cereals. 


Cereal. 

No.  of 
analyses. 

Nitrogenous 
substances. 

Fat. 

Nitrogen — 
free  extract- 
ives. 

Cellu- 
lose. 

Ash. 

Nitro- 
gen. 

Wheat  .    .    . 
Rye,  winter 
Barley  .    .    . 
Oats  .... 

1358 
173 
766 

377 
80 
10 

Per  ct. 

I3-89 
12.48 
II.24 
12.13 
II.74 
7.OO 

Perct. 
2.20 

i-77 
i-93 
4-99 

4.78 
2.00 

Per  ct. 

79-75 
81.04 

77.24 

66.41 
79.20 

84.76 

Per  ct. 
2.I9 

I.78 

4-95 

10.58 

1.67 

4.00 

Per  ct. 
I.97 
2.06 
2.42 

3-29 
1.40 
1. 16 

Per  ct. 
2.22 
2.00 
I.79 
I.94 

Corn,  flint     . 
Rice.    .    .    . 

1.88 
1. 12 

Composition  of  the  LeguminoscB. 


Beans 
Peas  . 


No.  of 
analyses. 


63 
72 


Nitrogenous 
substances. 


Per  ct. 
29.26 
26.39 


Per  ct. 
1. 68 
1-39 


Nitrogen — ■ 
free  extract- 


Per  ct. 
55.86 
6I.2I 


Cellu- 
lose. 


Per  ct. 
8.06 

5-68 


Per  ct. 
3-13 

2.68 


Nitro- 
gen. 


Per  ct. 
4.68 
4-3° 


The  high  protein  content  of  the  legumes  renders  them 
a  valuable  source  of  nitrogen.  They  are  compara- 
tively low  in  price,  and  are  therefore  at  the  command  of 
families  in  the  poorest  circumstances.  Their  digestibility 
and  flavor  are  dependent  largely  upon  the  method  of 
preparation.  When  used  in  excessive  amounts  they  give 
rise  to  flatulency,  and  hence  should  always  be  combined 
with  other  articles  of  food. 

The  proportion  of  water  in  vegetable  foods  varies 
greatly,  ranging  from  about  90  per  cent,  in  beets  and 
turnips,  to  as  low  as  10  per  cent,  in  some  kinds  of  flour. 
In  general,  the  dry  seeds,  as  wheat,  corn,  beans,  and  dif- 
ferent kinds  of  flour,  contain  about  one-eighth  part  water 
and  about  seven-eighths  parts  nutrients.  Beans  and  peas 
contain  the  largest  proportions  of  proteid  matter,  and 
cornmeal,  potatoes,  rice,  turnips,  and  beets  the  least.  Of 
the  cereals,  wheat  is  the  richest  in  proteid  material. 
Wheat  bread  differs  from  wheat  flour  principally  in  the 
greater  proportion  of  water  present. 


220  FOOD  AND  DIETING. 

Comparison  of  Flour  and  Bread  (Atwater). 


"Wheat  flour     . 
Baker's  bread 


Water. 

Nutri- 
ents. 

Proteid 
matter. 

Fat. 

Carbo- 
hydrates. 

Mineral 
matter. 

Per  ct. 
I2.00 

32.OO 

Per  ct. 

S8.00 

68.OO 

Per  ct. 

I2.00 

9.OO 

Per  ct. 
I. OO 

2.00 

Per  ct. 
74.OO 
56.OO 

Per  ct. 

1.00 
1.00 

Fuel  value 
of  1  gram. 


Calories. 
3.616 

2.S66 


Bread. — In  bread-making  the  changes  brought  about 
by  the  process  are  twofold.  The  carbon  dioxid  gener- 
ated by  the  yeast,  or  forced  into  the  dough,  causes  it  to  be 
light  and  filled  with  small  cavities.  If  the  carbon  dioxid 
is  generated  by  the  fermentative  action  of  the  yeast  plant, 
the  sugar  present  is  converted  into  carbon  dioxid,  and  at 
the  same  time  a  little  lactic  and  butyric  acids  are  formed, 
besides  some  extractive  matter.  A  portion  of  the  starch 
is  also  converted  into  dextrin  and  sugar.  During  the 
process  of  baking  the  fermentative  action  of  the  yeast 
plant  is  arrested  and  a  portion  of  the  albumin  is  coagu- 
lated. In  bread  made  with  the  aid  of  baking-powders  or 
by  forcing  carbon  dioxid  into  the  dough  the  products  of 
fermentation  are  absent,  and  the  only  change  produced 
is  that  brought  about  bv  the  heat  in  baking. 

Baking=powders. — There  are  three  classes  of  baking- 
powders  in  use,  the  one  class  deriving  its  carbon  dioxid 
from  sodium  or  ammonium  carbonate  through  the  action 
of  tartaric  acid.  These  are  frequently  called  "  cream-of- 
tartar"  baking-powders,  because  potassium  acid  tartrate 
is  used  to  act  upon  the  sodium  carbonate,  or  bicarbonate, 
to  generate  the  carbon  dioxid.  Another  class  of  baking- 
powders  differs  from  the  foregoing  in  the  use  of  phosphoric 
acid;  these  are  called  the  phosphatic  baking-powders. 
The  other  class  of  baking-powders  is  the  "alum"  bak- 
ing-powders, because  in  these  the  double  sulphate  of 
aluminum  and  sodium  is  generally  employed  to  act  upon 
the  carbonate  to  generate  the  carbon  dioxid.  This  class 
of  baking-powders  is  considered  injurious  to  health.  A 
great  deal  of  evidence  has  been  collected  by  a  committee 
of  the  United  States  Senate,  which  uniformly  condemns 


PRESERVED   VEGETABLE  FOODS.  221 

the  use  of  alum  baking-powders.  The  continued  use  of 
alum  is  injurious  to  health,  because  of  its  irritant  and 
astringent  action  in  the  alimentary  tract,  and  when  con- 
tinued for  a  long  time  it  impairs  nutrition.  The  alum 
interferes  with  the  secretion  of  the  gastric  juice,  and  has 
an  irritant  action  on  the  intestines,  and  in  time  leads  to 
constipation,  and  in  certain  instances  to  disease  of  the  kid- 
neys. The  alum  baking-powders  also  produce  a  heavier 
and  more  indigestible  bread  than  the  cream-of-tartar 
baking-powders.  The  use  of  alum  in  food,  in  any  form, 
is  prohibited  in  England,  France,  and  Germany. 

Preserved  Vegetable  Foods. — Vegetable  foods  may 
be  preserved  in  several  ways.  The  method  which  has 
long  been  in  use  is  that  of  drying-  This  method  is  still 
used  very  generally  in  preserving  certain  kinds  of  food. 
The  modification  of  this  method  in  use  in  large  manu- 
factories consists  in  exposing  the  fruit  to  the  fumes  of 
burning  sulphur  in  a  special  apparatus.  The  fruit,  when 
contained  in  galvanized-iron  trays,  is  certain  to  take  up 
appreciable  amounts  of  zinc  oxid.  This  fact  has  led  to 
restriction  of  the  importation  of  American  dried  fruits 
into  foreign  countries.  The  substitution  of  wooden, 
tin,  or  aluminum  trays  will  obviate  the  danger  of  con- 
tamination with  zinc.  The  amount  of  zinc  formed  aver- 
ages about  10  milligrams  for  every  ioo  grams  of  the 
fruit.  While  this  amount  of  zinc  is  probably  harmless 
when  taken  occasionally,  yet  when  constantly  present  in 
food  may  produce  derangement  of  health  through  its 
irritant  effect. 

Another  method  of  preserving  vegetable  foods  is  by 
means  of  heat.  This  method  is  unobjectionable  where 
the  food  is  stored  in  containers  that  yield  no  poisonous 
substances.  The  preservation  of  vegetable  foods  in  tin 
cans  is  quite  common,  and  there  is  some  danger  of 
lead-poisoning  from  these  foods  on  account  of  the 
presence  of  lead  in  the  solder  employed  in  sealing  the 
cans.  This  is  especially  the  case  with  acid  foods  or 
foods  that  have  been  imperfectly  preserved  so  that  the 


222  FOOD  AND  DIETING. 

putrefactive  organisms  are  not  all  destroyed.  In  such 
instances  there  is  danger  of  solution  of  the  lead  through 
the  action  of  bacterial  products  upon  the  solder. 

Vegetable  foods  may  also  be  preserved  by  the  addition 
of  antiseptic  substances,  so  as  to  prevent  the  growth  of 
micro-organisms.  The  antiseptics  most  commonly  em- 
ployed are  salicylic  acid  and  formaldehyd.  These  sub- 
stances are  in  themselves  irritant  poisons  when  taken  in 
certain  amounts,  while  smaller  amounts  used  for  a  long 
time  are  positively  injurious,  because  of  the  irritant 
effect  produced  on  the  gastro-intestinal  tract,  and  the 
inhibiting  influence  which  they  produce  on  the  digestive 
processes.  They'  are  also  injurious  through  the  action 
they  have  on  albuminous  food-substances,  in  that  they 
render  them  difficult  of  digestion.  The  use  of  all  pre- 
servatives of  this  class  should  be  strictly  prohibited  by 
law.  Senate  bill  No.  4047,  Fifty-sixth  Congress,  when 
enacted,  will  prohibit  the  use  of  these  and  other  food 
preservatives  and  adulterants. 

Food  preservatives  have  been  investigated  by  Prof. 
Bigelow,  of  the  Agricultural  Department  at  Washing- 
ton, who  finds  that  the  manufacture  of  them  has  be- 
come a  distinct  line  of  business.  Out  of  67  samples 
of  the  most  common  preservatives  in  use,  each  of 
which  was  obtained  with  great  difficulty  when  it  was 
known  that  it  was  wanted  for  a  chemical  analysis,  33 
contained  borax  or  boric  acid;  10  sodium,  potassium, 
or  calcium  sulphite;  8  salicylic  acid  or  its  sodium  com- 
pound; 7  benzoic  acid  or  its  sodium  compound;  1  boric 
acid  and  salicylic  acid;  1  boric  acid  and  ammonium 
fiuorid;  2  pyroligneousacid;  and  1 /9-naphtol.  Prof.  Bige- 
low holds  that  those  undoubtedly  injurious,  such  as 
formaldehyd,  salicylic  acid,  and  sulphites,  should  be  pro- 
scribed, and  a  stringent  law  enacted  to  control  the  use 
of  the  less  harmful  ones. 

Mineral  Food. — The  most  important  mineral  food  is 
sodium  chlorid.  It  plays  an  important  role  in  favor- 
ing the   secretion  of  the    digestive    fluids.     A  drop    of 


BE  VERA  GES  AND  CONDIMENTS.  223 

dilute  salt  solution  placed  upon  the  gastric  mucous 
membrane  of  an  animal  causes  a  pouring  out  of  gastric 
juice  by  the  glands  of  the  stomach.  When  taken  into 
the  mouth  it  causes  the  saliva  to  flow  freely.  Vegetable 
foods  are  somewhat  deficient  in  salts,  and  require  the 
addition  of  sodium  chlorid  to  make  up  this  deficiency,  as 
well  as  to  enhance  their  flavor  and  palatability.  The 
vegetable  foods  are  richer  in  potassium  salts,  and  these, 
combining  with  the  sodium  salts  of  the  body,  cause  an 
increased  excretion  of  the  latter;  this  action  being  com- 
pensated by  the  addition  of  sodium  chlorid  to  the  food. 
The  amount  of  sodium  chlorid  taken  during  a  year  in  a 
mixed  diet  ranges  from  5  to  7  kilograms. 

The  other  mineral  food-substances  contained  in  both 
vegetable  and  animal  food  are  calcium  and  potassium 
phosphate;  potassium,  calcium,  and  sodium  carbonate; 
and  magnesium  phosphate.  All  of  these  mineral  sub- 
stances have  important  nutritive  functions  in  the  body, 
but  they  are  present  in  sufficient  quantities  in  mixed 
diets,   so  that  no  further  additions  are  required. 

Beverages  and  Condiments. — Beverages  may  be 
classed  as  alcoholic  and  non-alcoholic.  The  alcoholic 
beverages  differ  from  each  other  not  only  in  the  quantity 
of  alcohol  present,  but  also  with  regard  to  the  presence 
of  various  extractive  substances  and  the  amount  and 
character  of  the  mineral  constituents. 

Alcoholic  Beverages. — Physiologic  experiments  have 
demonstrated  that  the  alcoholic  beverages  may  be  regarded 
as  articles  of  food,  not  only  on  account  of  the  quantity  of 
alcohol  present,  but  also  on  account  of  the  extractives 
which  they  contain.  They  serve  to  stimulate  the  diges- 
tion, the  circulation,  and  the  nervous  system.  They  also 
diminish  the  oxidation  processes  of  the  body  and  lower 
the  temperature.  Small  amounts  of  alcohol  may  be 
taken  daily  in  the  food,  and,  according  to  Prof.  At- 
water's  experiments,  these  small  amounts  are  oxidized 
in  the  svstem  and  are  therefore  a  source  of  enersv. 

The  principal  objection  to  the  use  of  alcoholic  bever- 


224  FOOD  AND  DIETING. 

ages  is  the  fact  that  their  constant  use  tends  to  the 
acquirement  of  the  drink-habit.  The  constant  use  of 
large  amounts  of  alcohol  leads  to  grave  derangement  of 
health,  and  for  this  reason  the  use  of  alcoholic  beverages 
is  to  be  condemned,  except  under  special  conditions  in 
disease  where  such  a  stimulant  may  be  required. 

Non=alcoholic  Beverages — The  more  important  non- 
alcoholic beverages,  besides  water,  are  tea,  coffee,  and 
cocoa.  These  beverages  have  a  stimulating  effect  because 
of  the  presence  of  an  alkaloid  in  each — thein  in  tea, 
caffein  in  coffee,  and  theobromin  in  cocoa.  Besides 
these  alkaloids  they  contain  various  extractive  substances 
and  volatile  oils,  to  which  they  owe  their  peculiar  aroma. 
These  beverages  have  no  nutritive  qualities  in  them- 
selves of  any  moment,  but  the  addition  of  sugar  and 
milk  makes  them  nutritious.  Their  principal  effect  is 
one  of  stimulation.  They  are  used  largely  as  conve- 
nient modes  of  administering  water  with  the  food. 

The  chief  hygienic  interest  of  these  beverages  is 
in  the  effects  produced  by  excessive  usage.  The  effects 
produced  are  most  commonly  insomnia,  nervous  irrita- 
bility, indigestion,  and  palpitation  of  the  heart. 

Consumption  of  Fluids. —  The  American  Grocer  has 
been  collecting  statistics  concerning  the  home  consump- 
tion of  beverages,  excepting  water  and  soda-fountain 
products,  for  the  year  1900.  According  to  this  authority, 
the  amount  spent  was  $1,228,674,925,  in  the  following 
proportions: 

Alcoholic  drinks $1,059,563,787 

Coffee 125,798,530 

Tea 37,312,608 

Cocoa 6,000,000 

Total $1, 228, 674,925 

The  consumption  of  spirits  per  capita  fell  from  5.4 
liters  in  1891  to  4.8  liters  in  1900;  wine,  from  1.7  to  1.5 
liters;  and  beer  increased  from  57.9  to  60.6  liters.  This 
indicates  that,  in  general,  the  use  of  alcoholic  beverages 
is  not  on  the  increase. 

Condiments. — Condiments  are  substances  added  to  food 


ADUL  TERA  TIONS  OF  FOOD.  225 

to  increase  its  palatability  and  to  stimulate  the  appetite. 
The  principal  condiments  are  vinegar  and  lime-  and 
lemon-juice  when  acids  are  desired,  and  mustard  and 
pepper.  These  substances  play  an  important  part  in 
digestion  and  nutrition.  Their  principal  hygienic  inter- 
est is  with  regard  to  excessive  usage.  The  excessive  use 
of  vinegar  tends  to  produce  a  watery  condition  of  the 
blood,  and  is  therefore  injurious.  The  excessive  use  of 
mustard  and  pepper  produces  overstimulation  of  the 
digestive  function,  and  finally  leads  to  irritation  and  in- 
flammation  of  the  mucous  membrane  of  the  gastro- 
intestinal tract. 

Adulterations  of  Food. — Adulterations  of  food  are  of 
two  kinds,  injurious  and  non-injurious  to  health.  Those 
which  are  without  injurious  effect  are  the  most  numerous, 
yet  they  are  of  importance  because  of  their  fraudulent 
character.  They  are  chiefly  of  two  kinds,  the  substitu- 
tion of  an  inferior  grade  and  the  substitution  of  inert 
foreign  substances.  They  are  of  hygienic  importance 
because  the  food  so  adulterated  is  of  lower  nutritive  value, 
and  may,  therefore,  lead  to  deficient  nutrition.  In  this 
manner  they  may  pave  the  way  to  disease  by  reducing 
the  natural  resistance  of  the  body.  A  large  majority  of 
this  class  of  adulterants  is  used  to  increase  bulk  and 
weight,  cheapen  the  article,  and  rob  the  consumer. 
Among  the  poisonous  adulterants  employed  are  those 
used  to  color  and  cheapen  confectionery,  liquors,  and 
canned  vegetables,  and  the  various  antiseptics  employed 
to  preserve  food. 

Milk  is  most  frequently  adulterated  by  the  addition  of 
water,  and  at  times  by  the  abstraction  of  some  of  the 
cream.  Both  forms  of  tampering  are  not  directlv  inju- 
rious to  health,  as  a  rule,  but  may  be  indirectly  injurious 
because  of  the  altered  nutritive  character  of  the  tam- 
pered milk.  This  form  of  adulteration  may  also  be 
directly  injurious  to  health  when  the  milk  is  diluted 
with  polluted  water.  Milk  is  also  adulterated  by  the 
addition    of    coloring-matter    to    conceal    dilution    with 

15 


226  FOOD  AND  DIETING. 

water  and  the  abstraction  of  cream,  as  well  as  by  the 
addition  of  various  preservatives.  The  latter  are  all 
directly  injurious  to  health  when  used  for  a  considerable 
time  in  the  amounts  added  to  preserve  the  milk. 

Butter  is  usually  adulterated  by  the  addition  of  other 
animal  and  vegetable  fats,  or  the  entire  substitution  of 
these  fats  for  the  butter  fats.  While  these  fats  are  some- 
what more  difficult  of  digestion,  they  are  perhaps  not 
otherwise  injurious  to  health.  The  custom  of  adding 
chemical  preservatives  to  the  milk  supplied  to  creameries, 
as  now  practised  by  small  farmers  who  store  the  milk  for 
several  days  before  delivering  it,  yields  butter  containing 
these  preservatives.  Such  butter,  when  used  constantly 
in  large  quantities,  may  prove  injurious  to  health. 

Tea  is  adulterated  in  different  ways.  It  may  be  treated 
with  different  substances  to  impart  a  definite  color  to  the 
leaves;  it  may  be  partly  exhausted  of  its  active  principle 
and  extractives  ;  there  may  be  a  substitution  of  foreign 
leaves,  such  as  those  of  the  ash,  willow,  sloe,  birch, 
hawthorn,  raspberry,  etc. ;  the  addition  of  foreign  astrin- 
gents, as  catechu  ;  or  the  addition  of  different  forms  of 
mineral  matter,  as  soapstone,  gypsum,  iron  salts,  copper, 
sand,  etc. 

Coffee  is  adulterated  by  the  addition  of  coloring-matter, 
the  addition  and  substitution  of  chicory,  acorns,  figs, 
leguminous  seeds  and  cereals.  While  these  substitutes, 
or  imitation  coffees,  are  without  detriment  to  health,  the}' 
are  distinct  frauds,  and  are  indirectly  injurious  when  the 
stimulating  influence  is  especially  desired. 

Cocoa  is  very  commonly  adulterated,  and   sugar  and. 
starch   are  most  frequently  employed  for   this   purpose. 
The  addition  of  these  adulterants  necessitates  the  addi- 
tion of  some  coloring-matter  to  conceal  their  presence. 

Lard  is  commonly  adulterated  by  the  addition  and 
substitution  of  cottonseed  oil;  stearins  derived  from  lard, 
beef  fat,  and  cottonseed  oil;  and  the  fat  of  animals  that 
have  died  of  disease. 

Canned  vegetables  are  adulterated  by  the  addition  of 


ADUL  TERA  TIONS  OF  FOOD.  227 

salts  of  copper  and  zinc  to  give  them  a  bright-green  color. 
These  salts  are  often  present  in  sufficient  quantities  to  be 
directly  poisonous.  Canned  vegetables  are  also  frequently 
adulterated  by  the  addition  of  antiseptic  substances  to 
assist  in  preserving  them.  These  substances  are  all  more 
or  less  poisonous,  especially  when  used  for  some  time. 
Canned  vegetables  also  frequently  contain  lead  from  the 
vessels  containing  them.  In  Germany  the  law  requires 
that  the  tins  employed  to  hold  the  canned  good  shall  not 
contain  more  than  1  per  cent,  of  lead.  In  this  country 
there  is  no  restriction,  and  as  high  as  12  per  cent,  of  lead 
has  been  found. 

Malt  liquors  are  most  frequently  adulterated  by  the 
addition  of  preservatives,  especially  salicylic  acid.  The 
presence  of  salicylic  acid  in  beer,  for  instance,  cannot 
fail,  in  time,  to  give  rise  to  disturbances  of  the  health  in 
those  who  take  large  quantities  of  it  daily. 

Mustard  and  pepper  are  frequently  adulterated  by  the 
addition  of  flour,  rice,  corn,  and  ginger. 

Vinegar  is  adulterated  by  the  addition  of  the  mineral 
acids  and  water. 

In  1898  the  General  Assembly  of  Kentucky  enacted  a 
law  providing  for  the  inspection  of  food-products  sold  in 
that  State.  During  1898  and  1899,  727  samples  of  food- 
products  were  collected,  of  which  290  were  found  to  be 
adulterated.  The  inspectors  state  that  "fully  40  per 
cent,  of  all  samples  of  food  taken  have  been  found  adul- 
terated. Some  of  the  adulterants  used  are  injurious  to 
health;  others  have  been  put  in  to  cheapen  articles  of 
food."  As  examples  of  the  former,  the  inspectors  found 
so-called  "  fruit  jellies  "  made  wholly  or  in  part  of  glue 
and  artificial  coloring-  and  flavoring-matters.  Thev 
found  salicylic  acid,  sometimes  in  large  quantities,  in 
tomato  catsups,  preserves,  and  other  food-products  which 
were  sold  as  pure,  and  formaldehyd  and  other  preserva- 
tives in  milk.  The  most  striking  example  of  this  form 
of  adulteration  was  found  in  essence  of  peppermint  and 
essence   of  cinnamon.     These   extracts    both    contained 


22S  FOOD  AND  DIETING. 

wood  alcohol  as  one  of  the  ingredients.  These  analyses 
indicate  the  great  necessity  of  the  systematic  control  of 
all  food-products,  in  order  to  prevent  fraud  and  injury 
from  adulterations. 

A  committee  of  the  United  States  Senate  has  investigated 
the  extent  of  food  adulterations  in  this  country,  and  the 
disclosures  made  by  eminent  chemists  show  adulteration 
of  a  large  number  of  food-products.  Samples  of  coffee  ber- 
ries were  submitted  to  the  committee  (which  could  not  be 
distinguished  from  the  genuine  by  casual  examination), 
that  were  composed  of  clay ;  spices  that  were  prepared  from 
prune-stones  and  cocoanut-shells;  mustard  consisting  prin- 
cipally of  plaster-of-Paris;  pepper  which  was  90  per  cent, 
charcoal  and  sawdust;  wheat  flour  which  contained  only 
a  small  percentage  'of  residue  of  wheat;  jellies  made  of 
glucose  and  starch  colored  and  flavored  artificially,  and 
preserved  with  salicylic  acid;  and  olive  oil  which  con- 
tained less  than  10  per  cent,  extract  of  olives,  the  prin- 
cipal ingredient  being  cottonseed  oil.  All  of  these  sam- 
ples had  been  purchased  in  the  market.  Other  adultera- 
tions which  these  chemists  frequently  found  were:  Sali- 
cylic acid  in  beer;  temperance  drinks,  such  as  raspberrv 
soda,  containing  sufficient  anilin  dye  in  a  glassful  to  color 
a  piece  of  flannel  12.5  centimeters  (5  inches)  square;  and 
the  extensive  use  of  borax  as  a  preservative  for  meat, 
poultry,  and  fish.  While  only  a  few  of  these  adulter- 
ants are  directly  prejudicial  to  health,  they  are,  however, 
gross  frauds,  and  should  be  prohibited. 

Some  of  the  chemists  appearing  before  the  committee 
suggested  the  enactment  of  a  law  compelling  manufact- 
urers to  sell  their  products  under  labels  stating  exactly 
the  contents  of  the  packages.  They  also  favored  the 
fixing  of  a  United  States  standard  of  purity  of  all  food- 
products,  including  liquors,  and  the  appointment  of  a 
commission  of  scientific  experts  to  fix  such  standards. 

Dietaries. — The  diet  of  different  individuals  is  in- 
fluenced by  a  great  many  conditions,  such  as  the  finan- 
cial   and    social    status,    the    age,    sex,    and    state     of 


DIETARIES.  229 

health,  the  temperature  and  climate  of  the  place,  the 
amount  of  work  performed,  and  the  availability  of  dif- 
ferent articles  of  food.  Diet  is  also  influenced  to  a  great 
extent  by  the  habits  and  idiosyncrasies  of  the  individual. 
Moleschott's  standard  diet  is  generally  considered  to  be 
a  fair  average  diet  for  an  adult  man.  According  to 
De  Chaumont,  a  certain  definite  proportion  between  the 
carbon  and  nitrogen  ought  to  be  maintained.  This 
proportion  should  be  nitrogen  1  to  carbon  15. 

Diet  in  Infancy — The  natural  diet  of  infants  for  the 
first  fifteen  to  eighteen  months  is  the  mother's  milk.  If 
this  fails,  it  is  necessary  to  substitute  some  artificial  food. 
The  best  substitute  for  mother's  milk  is  cows'  milk. 
Since  cows'  milk  is  richer  in  proteid  material  and  poorer 
in  sugar  than  mother's  milk,  it  is  necessary  to  dilute  the 
milk  and  at  the  same  time  sweeten  it.  The  extent  of 
the  dilution  of  cows'  milk  required  must  be  determined 
with  regard  to  the  purity  and  richness  of  the  cows'  milk, 
and,  especially,  with  reference  to  the  digestive  powers  of 
the  infant.  All  farinaceous  foods  should  be  avoided  until 
the  incisor  teeth  have  made  their  appearance. 

Diet  in  Childhood. — After  the  period  of  infancy  the 
diet  may  be  gradually  varied  by  the  addition  of  rice  or 
arrowroot  to  the  milk,  and  by  supplying  one  soft-boiled 
egg  daily.  Konig  gives  the  following  as  a  complete  daily 
diet  for  children  of  six  to  seventeen  years  of  age:  Meat 
(raw),  170  grams;  bread,  300  grams;  potatoes,  180  grams; 
fat  (butter  and  lard),  15  grams;  milk,  250  grams;  flour 
for  soup,  100  grams;  vegetables  (various),  180  grams;  or 
a  total  of  1 195  grams.  This  yields  78  grams  of  nitrogen, 
43.3  grams  of  fat,  and  281  grams  of  carbohydrates. 

Subsistence  Diet  for  Adults. — Playfair  gives  the  diet 
sufficient  for  the  internal  mechanical  work  of  the  body  as 
follows:  Proteids,  57  grams;  fat,  14  grams;  carbohydrates, 
340  grams;  and  salts,  14  grams;  but  it  is  doubtful  if  an 
average  man  could  subsist  on  this  diet  without  losing 
weight,  as  there  is  no  allowance  for  any  bodily  exertion. 
When  allowance  is  made  for  slight  bodily  exertion  the 


>3o 


FOOD  AND  DIETING. 


amounts  are  as  follows:  Proteids,  71  grams;  fats,  28 
grams;  carbohydrates,  340  grams;  and  salts,  14  grams. 
For  moderate  work  (93  kilogram-meters),  Moleschott 
gives  the  following  amounts  for  a  man  of  68  kilograms: 
Proteids,  130  grams;  fats,  84  grams;  carbohydrates,  404 
grams;  and  salts,  30  grams.  For  a  man  performing  very 
laborious  work,  or  for  a  soldier  in  the  field,  the  amounts 
should  be:  Proteids,  170  to  198  grams;  fats,  99  to  128; 
carbohydrates,  454  to  510  grams;  and  salts,  34  to  43 
grams. 

A  balanced  ration  is  a  diet  in  which  the  ingesta  are  just 
equal  to  the  excreta.  As  an  instance  of  complete  equi- 
librium in  a  man  weighing  70  kilograms,  embracing  both 
the  nitrogen  and  carbon  of  the  ingesta  and  excreta,  the 
following  balance  table  may  be  given  (Burdon-Sander- 
son): 


Incomings. 

Outgoings. 

Food. 

N. 

c. 

Excreta. 

N. 

c. 

100  gm.  proteids  .    .    . 

15-5 

53- 
79- 
93- 

14.4 
I.I 

6.16 
10.84 

250  gm.  carbohydrates 

208.00 

15-5 

225. 

15-5 

225. 

The  following  is  an  instance  of  a  balance  table  (Neu- 
meister)  of  a  man  weighing  70  kilograms,  showing 
nitrogenous  equilibrium  only,  some  of  the  carbon  of  the 
ingesta  (mostly  representing  stored  fat)  not  reappearing 
in  the  excreta: 


Incoming 

Outgoings 

Food. 

N. 
19.5 

c. 

Excreta. 

N. 

c. 

137  gm.  proteids .    .    . 

[315-5 

17.4 
2.1 

12.6 

14-5 

352  gm.  carbohydrates 

248.6 

19-5 

315-5 

19-5 

275-7 

It  has  been  found  that,  although  work  can  be  done  on 
a  non-nitrogenous  diet,  it  does  not  follow  that  nitrogen 


DIETARIES.  231 

is  unnecessary.  Experience  has  shown  that  nitrogen 
must  be  supplied  when  work  is  done,  and  that  the 
amount  must  increase  with  the  amount  of  work  done. 
When  no  nitrogen  is  ingested  the  body  uses  some  of  its 
own  nitrogen,  and  becomes  fatigued  after  a  small  amount 
of  work  is  performed. 

Diet  for  Old  Age — Konig  gives  the  minimum  diet  for 
an  old  man  as  follows:  Proteids,  100  grams;  fats,  68 
grams;  and  carbohydrates,  350  grams.  For  an  old 
woman  he  gives  the  following  amounts:  Proteids,  80 
grams;  fats,  50  grams;  and  carbohydrates,  260  grams. 
The  food  of  the  aged  should  be  easily  digested.  With 
decreased  physical  energy  the  digestive  powers  are  also 
lowered,  and  hence  the  nature  of  the  food  has  to  be 
regulated.  Over-indulgence  is  especially  to  be  avoided 
in  the  aged.  Milk,  grains,  and  fruit  are  well  adapted 
for  aged  persons. 

In  an  article  on  "Vegetarianism,"  A.  Schoenstadt1 
states  that:  "There  are  two  parties  among  vegetarians — 
the  one  excludes  all  animal  nutritive  materials  of  what- 
ever nature,  and  the  radical  adherents  live  on  only  a  few 
vegetables,  namely,  cereals,  fruit,  baked  food,  and  water. 
The  other  party  uses,  besides  vegetable  food,  also  animal 
food  materials  which  are  obtained  without  killing  the 
animals,  as  eggs,  milk,  cheese,  butter,  honey.  This  is 
really  not  vegetarianism,  but  a  mixed  diet." 

Schoenstadt  believes  that  it  is  possible  to  subsist  on  a 
purely  vegetable  diet,  but  states  that  it  is  not  sufficient 
nor  natural  for  man.  He  is  of  opinion  that  there  is  great 
danger  connected  with  a  vegetable  diet: 

a.  Because  the  nutritive  materials  supplied  are  in- 
sufficient to  meet  the  requirements  of  the  organism. 

b.  Because  this  diet  leads  to  grave  digestive  dis- 
turbances. 

He  regards  this  diet  as  insufficient  for  the  inmates  of 
institutions  and  prisons. 

Influence  of  Insufficient  Food. — Deficiency  in  proteid 

1  Deutsch.   Vierteljahr.  f.  oeffentl.  Gesundheitspflege,  Bd.  xxxii.,  S.  597. 


232  FOOD  AND  DIETING. 

materials  in  the  dietary  is  attended  with  lessened  activity 
and  a  general  lowering  of  the  vitality  of  the  body.  This 
adynamic  condition  favors  the  contraction  of  specific  dis- 
eases. The  omission  of  fats  from  the  dietary  results  in 
illness  in  a  few  days.  The  body  is  unable  to  make  up  its 
carbon  deficit  from  the  other  food-substances.  Starch 
can  be  omitted  from  the  dietary  for  a  long  time  without 
detriment  if  fat  is  given.  Deficiency  in  salts  in  the 
dietarv  is  attended  by  malnutrition  and  a  disorganized 
condition  of  the  blood. 

A  form  of  deficient  nutrition  which  was  formerly  quite 
common,  and  is  still  seen  at  times,  is  known  as  scurvy. 
This  condition  is  brought  about  by  a  deficiency  of  fresh 
vegetables  and  fresh  fruits,  and  sometimes  to  deficiency 
in  fresh  meats.  It  appears  to  be  due  to  the  absence  from 
the  dietary  of  certain  organic  acids  and  their  salts. 

Influence  of  Excessive  Amounts  of  Food. — When  much 
larger  amounts  of  food  are  taken  than  can  be  utilized 
bv  the  body  the  effects  are  manifested  in  dyspepsia, 
diarrhea,  and  gastro-intestinal  irritation.  Gout  is  a  con- 
dition of  the  system  in  which  the  function  of  the  liver 
and  kidneys  is  disturbed  because  of  long-continued  efforts 
at  eliminating  excessive  amounts  of  proteid  materials 
ingested  into  the  system.  Excessive  amounts  of  proteid 
material  with  deficient  fat  lead  to  wasting  of  the  body- 
fat.  Excessive  amounts  of  fat  and  starch  in  the  food 
lead  to  corpulency  and  disordered  function  of  the  diges- 
tive organs. 


CHAPTER    VIII. 
EXERCISE. 

In  order  to  maintain  a  perfect  state  of  health  of  the 
body  it  is  essential  that  each  organ  has  a  certain  amount 
of  exercise.  All  the  bodily  functions  are  attended  with 
rhythmic  motion,  and  these  movements  are  facilitated  by 
exercise.  If  there  is  deficient  exercise  of  a  portion  of 
the  body,  continued  for  some  time,  the  nutrition  of  this 
portion  is  impaired,  the  organs  or  members  involved 
decrease  in  size  and  eventually  degenerate  in  structure  as 
well  as  in  function.  Overexertion  of  a  portion  of  the 
body  leads  to  abnormal  nutrition  and  development  of  the 
organs  or  members  involved,  and  if  continued  for  some 
time  degeneration  may  occur,  which  is  as  great  as  that 
resulting  from  disuse  of  the  organs.  It  is  essential, 
therefore,  that  the  exercise  is  as  uniform  as  possible  for 
all  the  organs  and  members  of  the  body  so  as  to  avoid 
over-  or  under-stimulation  of  any  of  its  parts.  Perfect 
health  is  dependent  upon  the  uniform  stimulation  of  all 
the  functions,  so  that  all  the  organs  may  be  in  a  condition 
to  act  in  their  natural  way  and  normal  capacity. 

The  amount  of  energy  expended  in  walking  on  a  level 
is  usually  assumed  to  equal  that  required  to  lift  one- 
twentieth  of  the  body-weight  through  the  distance 
walked.  The  most  important  effect  of  muscular  exercise 
of  any  kind  is  produced  on  the  lungs  and  circulation. 

Effect  on  the  I/Ungs. — Smith  has  found  the  effect  of 
exercise  on  the  amount  of  air  respired,  to  vary  in  direct 
proportion  with  the  amount  of  exertion.  Taking  the 
recumbent  position  as  unity,  he  found  the  amounts  of 
air  inspired  as  follows: 

233 


234 


EXERCISE. 


Recumbent  position I.oo 

Sitting       I.iS 

Standing 1-33 

Singing 1. 26 

Walking  I  mile  per  hour  ....  1. 90 
Walking  2  miles  per  hour  .  .  .  2.76 
Walking  3  miles  per  hour  .  .  .  3.23 
Walking  and  carrying  15  kg.    .    .  3.50 


Walking  and  carrying  28.5  kg. 
Walking  and  carrying  53.5  kg. 
Walking  4  miles  per  hour 
Walking  6  miles  per  hour 
Riding  and  trotting    .    . 

Swimming 

Treadmill 


4-75 
5.00 
7.00 
4.05 
4-33 
5-5° 


Under  ordinary  circumstances  a  man  inspires  8.5  liters 
of  air  per  minute;  if  he  walks  6\  kilometers,  or  4  miles, 
per  hour  he  inspires  (8.5X4=)  34  liters;  if  he  walks 
gh  kilometers,  or  6  miles  per  hour  he  inspires  (8.5  X  6  =) 
51  liters.  With  increased  amount  of  work  there  is  an 
increased  amount  of  carbon  dioxid  exhaled.  The  rela- 
tive amount  of  carbon  dioxid  exhaled  is  greater,  the 
larger  the  amount  of  work  performed,  on  account  of  the 
increased  oxidation  because  of  the  muscular  exertion. 
Pettenkofer  and  Voit  found  the  relative  amounts  of 
oxygen  absorbed,  and  of  carbon  dioxid,  water,  and  urea 
eliminated  in  rest  and  while  at  work  to  be  as  follows: 


Weight  of  man  experimented  upon  = 
60  kilograms. 

Absorption 

Elimination  in  grams  ol" — 

of  oxygen 
in  grams. 

Carbon 
dioxid. 

Water. 

Urea. 

Work 

708.9 

954-5 

9H-5 

1284.2 

828.O 
2042.I 

37-2 
37-o 

Excess  and  deficiency  during  work    . 

245.6 

372.7 

I2I4.1 

0.2 

The  increased  amount  of  carbon  dioxid  eliminated 
during  exercise  indicates  the  necessity  of  an  increased 
amount  of  carbon  in  the  food  of  persons  performing 
work  requiring  much  muscular  effort.  This  increased 
amount  of  carbon  is  best  given  in  the  form  of  fats, 
rather  than  in  the  form  of  starches.  The  increased 
elimination  of  water  calls  for  an  increased  supply  of 
water  with  the  food,  and  especially  as  drink.  It  is 
preferable  to  take  this  in  the  form  of  plain  water. 
Alcoholic  beverages  decrease  the  elimination  of  carbon 
dioxid  by  the  lungs,    and   are  therefore  contraindicated 


EFFECT  ON  THE  CIRCULA  TION.  235 

during  muscular  exercise.  For  this  reason  all  alcoholic 
beverages  are  prohibited  for  athletes  while  in  training. 

Effect  on  the  Circulation. — The  first  effect  of  exercise 
is  to  increase  the  rapidity  and  force  of  the  heart  action, 
causing  increased  blood-supply  to  the  muscles,  as  well  as 
to  all  the  organs.  Excessive  exercise,  when  continued  for 
some  time,  leads  to  irregular  action  of  the  heart,  accom- 
panied by  great  rapidity  and  disturbance  of  its  rhythmic 
action.  Such  a  condition  is  highly  injurious,  and  calls 
for  prompt  cessation  of  the  exercise. 

Long-continued  strenuous  labor,  or  excessive  exercise, 
leads  to  hypertrophy  of  the  heart-muscle  and  increased 
caliber  of  the  heart  cavities.  Such  a  condition,  when 
once  established,  remains  permanent.  This  condition  is 
quite  common  in  laborers  who  have  performed  unusually 
hard  work  for  some  years,  in  soldiers  who  have  been 
obliged  to  take  very  long  and  forced  marches,  and  in 
athletes  who  have  been  in  hard  training  for  some  time. 

On  the  other  hand,  deficient  exercise  leads  to  degenera- 
tion of  the  heart-muscle,  weakening  of  the  heart  action 
and  of  the  general  circulation.  In  this  condition  there 
may  be  dilatation  of  the  heart  cavities  without  compen- 
satory hypertrophy  ;  unusual  deposition  of  fat  on  the  out- 
side of  the  heart,  and  even  between  the  muscular  bundles  ; 
and  fatty  degeneration  of  the  heart-muscle. 

In  beginning  athletic  training  the  heart  action  should 
be  carefully  noted  in  order  to  determine  whether  it  is 
properly  accommodating  itself  to  the  increased  demands 
made  upon  it  by  the  muscular  exercise,  as  well  as  the 
manner  in  which  it  behaves  during  the  period  of  rest 
after  the  exercise.  After  exercise  the  heart  action  grad- 
ually slows  down  and  falls  slightly  below  the  normal. 
The  extent  to  which  the  heart  action  falls  below  the 
normal  indicates  the  amount  of  fatigue  produced,  as  well 
as  the  compensating  power  of  the  heart. 

With  proper  care,  in  healthy  subjects,  there  is  no  great 
danger  from  athletic  training.  The  amount  of  exercise 
taken  should  be  gradually  increased  as  the  compensating 


236  EXERCISE. 

power  of  the  heart  increases  with  the  demands  made 
upon  it.  The  athletic  training  should  not  be  suddenly 
relinquished.  The  work  should  be  lessened  gradually, 
in  order  to  allow  the  heart  to  accustom  itself  gradually 
to  the  decreased  demands  of  everyday  life. 

Effect  on  the  Muscles. — The  result  of  repeated  con- 
traction and  relaxation  of  any  group  of  muscles  is  to 
cause  an  increase  in  the  muscular  fibers,  with  increased 
firmness  and  more  active  response  to  the  will-power. 
The  extent  of  growth  is  limited,  however,  and  when  the 
stimulation  is  long  continued,  or  excessive,  degenerative 
processes  set  in.  Under  such  conditions  the  muscles  be- 
come soft  and  flabby,  and  respond  imperfectly  and  feebly 
to  the  will.  During-  exercise  there  is  increased  tem- 
perature  in  the  muscles,  dependent  to  some  extent  upon 
the  amount  of  work  performed.  There  is  an  increased 
amount  of  carbon  dioxid  formed  in  the  muscles  as  the 
result  of  the  increased  oxidation. 

All  the  muscles  of  the  body  should  be  exercised  as 
uniformly  as  possible.  There  is  less  likelihood  of  mus- 
cular degeneration,  in  certain  groups  of  muscles,  when 
the  entire  muscular  system  is  required  to  do  a  certain 
amount  of  work.  In  training  for  any  particular  kind  of 
athletic  contest,  in  which  certain  groups  of  muscles  are 
specially  called  into  action,  it  is  best  to  vary  the  exercise 
continually  so  as  to  keep  all  the  muscles  fully  developed. 
For  this  purpose  the  training  should  be  so  conducted  as 
to  allow  a  period  of  rest  to  follow  the  special  exercise, 
and  then,  before  taking  up  the  training  again,  a  short 
period  of  exercise  in  the  gymnasium,  or  some  simple 
athletic  game,  should  be  indulged  in. 

Fatigue. — As  the  result  of  muscular  exercise  there  is 
a  feeling  of  exhaustion  and  fatigue,  amounting  some- 
times to  actual  pain  in  the  tired  muscles.  This  condition 
is  brought  about  by  the  accumulation  in  the  muscles  of 
the  products  of  their  activity,  especially  para-lactic  acid, 
and  to  deficiency  of  oxygen.  During  the  period  of  rest 
the  accumulated  products  are  eliminated  and  the  supply 


EFFECT  ON  THE  ELIMINA  TION  OF  NITROGEN.    237 

of  oxygen  is  renewed.  There  is  also  a  deficiency  of 
water  in  the  system  as  the  result  of  excessive  elimination, 
and  this  must  be  replaced.  Since  the  bodily  functions 
require  the  presence  of  a  considerable  amount  of  water  in 
the  system,  it  seems  essential  that  during  exercise  the 
loss  of  water  should  be  compensated  by  the  administra- 
tion of  small  amounts  of  water  at  short  intervals.  The 
fatigue  of  the  muscular  system  can  only  be  relieved  by  a 
period  of  rest.  The  heart-muscle,  under  ordinary  work, 
has  a  rest  between  the  contractions,  which  is  about  twice 
as  long  as  the  time  consumed  by  the  contractions,  and 
hence  it  requires  no  additional  rest  to  recover  itself. 

Effect  on  the  Nervous  System. — The  effect  of  exer- 
cise on  the  nervous  system  is  more  indirect  than  direct  in 
its  nature.  Moderate  exercise  assists  in  maintaining  all 
the  bodily  functions  in  their  normal  condition,  and  hence 
the  nervous  system  is  in  a  position  to  act  most  efficiently. 
This  fact  has  had  abundant  demonstration  in  recent 
years  since  athletic  sports  have  become  such  an  impor- 
tant feature  in  college  life.  It  has  been  found  that,  as  a 
rule,  the  best  athletes  are  rather  above  the  average  in 
their  class  records. 

Overtraining  is  of  course  detrimental  to  the  nervous 
system,  because  it  undermines  the  general  health.  The 
effect  of  active  exercise  upon  the  mental  activity  is 
dependent  to  a  certain  extent  upon  individual  conditions; 
but,  as  a  rule,  it  is  believed  to  be  perfectly  allowable  in 
students  that  are  able  to  keep  up  with  the  majority  of 
their  class.  It  is  better  to  attain  somewhat  lower  aver- 
ages in  class  standing  than  to  risk  a  breaking  down  of 
the  nervous  system  as  the  result  of  overstudy  or  the  ruin- 
ation of  the  general  health  because  of  too  close  applica- 
tion to  study. 

Bffect  on  the  Elimination  of  Nitrogen. — A  large 
number  of  experiments  have  been  made  to  determine  the 
relative  amounts  of  nitrogen  eliminated  during  rest  and 
exercise.  The  results  obtained  indicate  that  during  exer- 
cise the  amount  of  nitrogen  assimilated  is  increased  per- 


23&  EXERCISE. 

ceptibly.  The  metabolism  of  nitrogen  is  influenced 
somewhat  by  the  period  of  work  and  rest,  and  the 
severity  of  the  work  performed.  During  a  period  of 
active  exercise  the  amount  of  nitrogen  eliminated  from 
the  kidneys  is  slightly  diminished,  and  after  the  exercise 
there  is  a  slight  excess  of  nitrogen  excreted,  continuing 
for  some  time.  During  severe  exercise  the  amount  of 
nitrogen  eliminated  appears  to  be  increased.  Yoit  and 
Krummacher  are  of  the  opinion  that  usually  work  does 
not  directly  produce  a  greater  breaking  down  of  proteid 
matter,  but  that  an  increase  in  the  proteid  cleavage  is 
caused  by  the  increased  combustion  of  the  nitrogen-free 
materials  which  protect  the  proteid  matter.  If  it  were 
possible,  during  the  period  of  work,  to  supply  the  cells 
continuously  with  a  sufficient  amount  of  nitrogen-free 
material,  then  there  would  be  no  increase  in  the  quantity 
of  proteid  material  broken  down.  But  this  is  a  very  dif- 
ficult matter.  Krummacher  believes  that  the  after-effect 
of  muscular  labor  is  not  due  to  the  continued  excretion 
of  nitrogenous  cleavage-products,  but  to  the  fact  that  the 
nitrogen-free  materials  in  the  body  were  used  up,  and 
that  it  takes  some  time  to  provide  the  body  with  a  new 
supply.  In  active  exercise,  therefore,  an  increased 
amount  of  nitrogen  must  be  supplied  in  the  food,  as  well 
as  an  increased  amount  of  carbon.  There  must  also  be 
an  increased  supply  of  salts,  especially  sodium  chlorid 
and  potassium  phosphate,  to  supply  the  loss  in  these 
salts  during  exercise. 

Amount  of  Bxercise  that  Should  be  Taken. — A 
good  day's  work  for  an  average  man  is  considered  to  be 
150,000  kilogram -meters.  Haughton  has  shown  that 
walking  on  a  level  surface  at  the  rate  of  3  miles  (4. 8  kilom- 
eters) per  hour  is  about  equal  to  raising  one-twentieth 
of  the  weight  of  the  body  through  the  distance  walked. 

In  order  to  determine  the  work  performed  in  walking 
32,000  meters  per  day,  we  multiply  the  weight  of  the 
body  in  kilograms  by  the  distance  travelled,  the  result 
being    the   kilogram-meters  of   work   performed.      If  a 


AMOUNT  OF  EXERCISE  TO  BE  TAKEN.        239 

pedestrian  walks  32,000  meters  a  day,  without  a  load,  the 
energy  expended,  assuming  him  to  weigh  70  kilograms, 
is  32,000  X  70=  2,240,000  kilogram-meters.  Haughton 
divides  the  work  performed  into  "fatigue  work,"  the 
effort  necessary  to  carry  the  weight  of  the  body,  and 
' '  useful  work, ' '  the  energy  expended  in  performing 
labor.  For  instance,  Coulomb  observed  that  the  work 
done  by  porters  employed  to  carry  goods  2000  meters, 
returning  unloaded,  amounted  to  348  kilograms  in  six 
journeys,  or  58  kilograms  at  a  time.  The  useful  work 
performed  was,  therefore,  2000  X  348  =  696,000  kilogram- 
meters;  the  fatigue  work  was  2000  X  2  X  70  X  6  =  1,680,- 
000  kilogram-meters.  This  allows  70  kilograms  as  the 
weight  of  the  porter,  and  takes  into  consideration  that 
the  body  is  carried  in  both  directions,  or  4000  meters. 
The  total  energy  expended  was  2,376,000  kilogram- 
meters.  He  also  found  that  pedlars,  who  always  travelled 
loaded  with  their  packs,  were  able,  with  a  load  of  44 
kilograms,  to  travel  19,000  meters  per  day.  Assuming 
their  weight  of  70  kilograms,  we  find — 

19,000  x  44  =     836,000  kilogram-meters  =  useful  work. 
19,000  x  70  =  1,330,000  kilogram-meters  =  fatigue  work. 
Total  =  2,166,000  kilogram-meters. 

The  energy  expended  under  the  foregoing  conditions 
was,  then, 

Man  walking  without  a  load 2,240,000  kilogram-meters. 

Man  alternately  loaded  and  unloaded 2,376,000 

Man  loaded  all  day 2,166,000  " 

In  athletic  exercises  it  is  essential  that  the  amount  of 
energy  expended  be  carefully  determined,  in  order  to 
ascertain  whether  the  exercise  is  likely  to  prove  benefi- 
cial or  otherwise.  The  amount  of  energy  expended  in 
athletic  sports  should  not  exceed  that  expended  by  labor- 
ers in  hard  manual  labor — that  is,  about  150,000  kilo- 
gram-meters. In  athletic  contests,  of  course,  the 
energy  expended  is  often  in  excess  of  this  amount;  but 
a  period  of  comparative  rest  must  supervene  the  contest, 


240  EXERCISE. 

in  order  to  allow  the  body  to  recuperate  from  the  fatigue 
induced  by  the  contest.  The  harmful  effects  of  the 
large  amount  of  energy  expended  in  some  athletic  con- 
tests is  frequently  seen  when  these  contests  take  place  at 
too  short  intervals,  allowing  insufficient  time  for  the  con- 
testants to  recover  from  the  fatigue  of  the  previous  con- 
test. The  same  effects  are  also  noted  in  soldiers  who  are 
compelled  to  make  frequent  forced  marches  over  long 
distances. 

From  what  has  been  learned  of  the  effects  of  exercise, 
it  will  be  seen  that  athletic  training  should  aim  to  in- 
crease the  breathing-power;  to  strengthen  the  power  of 
the  heart's  action;  to  make  the  muscular  action  more 
vigorous  and  enduring;  and  to  decrease  the  amount  of 
fat.  These  results  are  obtained  by  careful  dieting;  by 
regular  and  systematic  exercise;  and  by  increasing  the 
action  of  the  eliminating  organs,  especially  the  skin. 


CHAPTER  IX. 
CLOTHING. 

The  objects  of  clothing  are  to  protect  against  the 
weather — heat,  cold,  and  dampness — and  to  protect 
against  injury.  All  other  uses  of  clothing  have  no 
direct  hygienic  interest,  only  indirectly  in  so  far  as  they 
may  be  injurious  to  health. 

Protection  against  Cold. — The  most  important  use 
of  clothing  in  cold  climates  is  to  protect  against  cold. 
Clothing  serves  this  purpose  by  diminishing  the  radiation 
of  heat  from  the  body.  The  radiation  of  heat  from  the 
body  diminishes  with  the  number  of  layers  of  clothing 
worn,  and  is  also  dependent  upon  the  nature  of  the 
clothing  worn.  If  we  take  the  amount  of  radiation  of 
heat  from  the  naked  body  as  ioo,  the  radiation  is  reduced 
to  73  by  means  of  a  woollen  shirt;  to  60  by  means  of 
both  a  woollen  and  a  linen  shirt;  to  46  by  means  of  a 
woollen  and  a  linen  shirt  and  a  vest;  to  33  by  the  addi- 
tion of  a  coat.  Rubner  found  that  if  the  radiation  at 
150  C.  is  taken  as  100,  at  230  C.  it  is  only  69,  at  290  C. 
it  is  56,  and  at  320  C.  it  is  31. 

The  radiation  of  heat  is  directly  dependent  upon  the 
thickness  of  the  layer  of  clothing.  If  we  take  the  loss  of 
heat  as  100,  a  thickness  of  1  millimeter  of  cotton  allows  a 
radiation  of  77  per  cent. ;  2  millimeters,  of  68  per  cent. ; 
3  millimeters,  of  65  per  cent. ;  4  millimeters,  of  57  per 
cent.;  5  millimeters,  of  53  percent.;  10  millimeters,  of 
41  per  cent. ;  15  millimeters,  of  30  per  cent. 

The  thickness  of  clothing,  in  our  climate,  must  not  be 
so  great  as  to  increase  perceptibly  the  air-pressure  by 
compression,  nor  so  thin  as  to  decrease  perceptibly  the 
air-pressure.     The  thickness  of  the  clothing  is,  therefore, 

16  241 


242  CLOTHING. 

one  of  the  most  important  features.  The  radiation  of 
heat  from  the  body  is  very  nearly  the  same  whatever  the 
nature  of  the  clothing.  Wool,  silk,  and  cotton  are 
equally  warm  when  thickness  of  the  layer  is  the  same. 
The  most  rational  clothing,  however,  is  that  which  con- 
serves the  heat  of  the  body  with  the  least  quantity  of 
material.  Flannel  would  be  the  lightest  and  warmest; 
but,  since  it  wears  so  rapidly,  woollen  cloths  are  more 
serviceable,  because  they  wear  better.  The  smoothly 
woven  cloths  are  not  so  warm  as  the  tricot  cloths,  but 
they  are  more  serviceable. 

The  clothing  should  not  only  be  light,  but  it  should 
functionate  well  with  regard  to  the  absorption  of  moist- 
ure from  the  skin.  It  should  take  up  the  moisture  as 
readily  as  possible,  and  should  quickly  dry  out.  For  this 
reason  the  clothing  worn  next  the  body  should  be  porous, 
so  that  all  the  pores  may  not  be  filled  with  perspiration. 
Closely  woven  goods  is  not  adapted  for  this  purpose. 
Some  authorities  claim  that  linen,  of  coarse  mesh,  is  best 
adapted  for  this  purpose  because  it  does  not  retain  the 
moisture  as  long  as  wool. 

Protection  against  Heat. — The  degree  of  porosity  is 
an  important  feature  in  summer  clothing.  The  color  of 
summer  clothing  is  also  important.  Dark  clothing  ab- 
sorbs heat  to  some  extent,  and  in  consequence  it  is  some- 
what warmer  than  white  fabrics  or  those  of  lighter  colors. 
The  degree  of  porosity  is,  however,  the  most  important 
factor,  because  on  this  property  depends  the  interchange 
of  air  through  the  skin.  The  effect  of  the  direct  radia- 
tion of  heat  from  the  sun  may  be  inhibited  in  part  by  a 
proper  covering  of  the  head.  For  this  purpose  straw  hats 
with  broad  brims  are  most  serviceable.  They  shade  the 
head  and  face,  and  allow  free  ventilation  of  the  scalp, 
with  a  layer  of  air  between  the  head  and  the  covering. 
This  is  important,  because  air  is  a  poor  conductor  of  heat. 

Protection  against  Dampness.  —  During  rainy 
weather  the  use  of  some  impervious  material  serves  to  ex- 
clude the  dampness  from  the  body  and  clothing.     Damp 


PROTECTION  AGAINST  INJURY. 


243 


clothing  is  injurious  not  only  because  it  is  liable  to  pro- 
duce chill,  but  because  it  prevents  the  free  evaporation 
of  heat  and  moisture  from  the  surface  of  the  body.  The 
importance  of  keeping  the  clothing  dry  in  rainy  weather 
is  therefore  self-evident. 

Protection  against  Injury. — Clothing  protects  the 
body  against  mechanical  injury,  from  frost,  or  from  the 
direct  rays  of  the  sun.  Among  civilized  peoples  pro- 
tection of  the  feet  is  also  necessary  to  avoid  injury  or 
annoyance  in  walking  over  rough  ground.  The  sole  of 
the  shoe  should  conform  to  the  shape  of  the  foot.      This 


Fig.  45. — Correct  sole 
(Hueppe). 


Fig.  46. — Shoemaker's 
sole  (Hueppe). 


is  of  the  greatest  importance.  The  length  of  the  sole  is  the 
so-called  Meyer  line  (Fig.  45,  ad),  which  extends  from 
the  middle  of  the  heel  through  the  middle  of  the  great 
toe,  and  lies  parallel  with  the  inner  border  of  the  anterior 
half  of  the  foot.  The  breadth  of  the  sole  is  indicated  by 
the  Starck  line  (Fig.  45,  cd),  which  extends  diagonally 
from  the  head  of  the  first  metatarsal  bone  to  form  the 
letter  V.  The  shoemaker's  sole  is  usually  cut  so  that 
the  shoe  is  symmetrically  divided  right  and  left  by  a  line 
extending  through  the  middle,  and  which  commonly  cor- 
responds to  the  anatomical  axis  (Fig.  46).     As  the  result 


244 


CLOTHING. 


of  wearing  shoes   with  soles   of  this   pattern  we    have 
subluxations  of  the  great  toe  at  s,  whereby  the  latter  is 


Fig.  47. — Normal  feet  (Whitman). 


Fig.    48. — Proper  soles   for  normal 
feet  (Whitman). 


forced  outward  and  increases  the  prominence  of  the  ball 
of  the  ereat  toe.     This  decreases  the  room  for  the  other 


Fig.  49. — Deformed  feet 

(Whitman). 


Fig.   50. — Shoemakers'   soles 
(Whitman). 


toes,  and,  in  consequence,  these  are  superimposed  upon 
each  other,  instead  of  lying  side  by  side. 

Figs.   47,   48,   49,   and    50   also   give    the    outlines   of 


INJURIOUS  EFFECTS  OF  CLOTHING.  245 

normal  feet  and  the  manner  -in  which  these  normal  out- 
lines are  deformed  by  the  universal  soles  of  the  shoe- 
maker. It  will  be  seen  that  the  shoemakers'  soles,  as 
figured  by  Whitman,  in  no  way  conform  to  the  outlines 
of  normal  feet. 

The  heels  should  be  low,  broad,  and  long,  so  as  to 
afford  proper  support  to  the  body.  High  heels  are  espe- 
cially injurious,  because  they  place  the  larger  part  of  the 
weight  of  the  body  on  the  ball  of  the  foot.  The  shoes 
should  not  be  so  tight  as  to  compress  the  feet.  Laced 
shoes  are  the  most  rational,  because  they  can  be  fastened 
to  the  feet  in  such  a  manner  as  to  allow  the  least  amount 
of  friction.  Rubber  shoes  should  be  worn  only  for  a 
short  time  during  wet  weather,  and  should  be  removed  as 
soon  as  they  are  not  needed. 

Injurious  Effects  of  Clothing. — The  clothing  should 
be  of  such  a  pattern  as  to  conform  to  the  natural  shape 
of  the  body  without  constricting  or  compressing  any  por- 
tion thereof.  With  regard  to  the  covering  of  the  feet, 
this  point  has  already  been  discussed.  Above  all,  there 
should  be  no  constriction  of  the  chest  and  abdomen. 
The  abdominal  organs  and  the  lungs  and  heart  should  be 
as  free  to  act  as  possible.  The  clothing  worn  by  men  is 
quite  rational  with  this  respect,  but  that  worn  by  women, 
in  general,  is  most  irrational.  The  wearing  of  corsets  is 
highly  injurious,  as  has  been  frequently  proved,  and  it  is 
unnecessary  to  adduce  facts  to  prove  the  statement.  Cor- 
sets compress  the  chest  and  abdomen,  thus  impeding 
respiration  and  the  movements  of  the  heart.  The  abdom- 
inal organs  are  also  compressed  and  correspondingly 
interfered  with  in  their  normal  functions.  The  use  of 
tight  garters  is  also  injurious.  The  clothing  of  women 
should  be  suspended  from  the  shoulders  and  not  from  the 
hips,  in  order  to  diffuse  the  weight  more  evenly. 

The  wearing  of  heavy  head-coverings  is  also  injurious, 
because  it  places  a  constant  weight  upon  the  spinal  col- 
umn. The  use  of  veils  is  especially  injurious,  because 
of  the  obstructed  vision  which  they  induce.     The  com- 


246  CLOTHING. 

bination  head-covering  worn  by  women  in  mourning  is 
injurious,  and  frequently  leads  to  persistent  nervous  trou- 
ble, as  well  as  to  general  fatigue  from  its  weight.  It  is 
not  unusual  to  see  spinal  curvature  follow  prolonged  wear- 
ing of  the  head-covering  fashionable  in  mourning. 

Reforms  in  dress  are  quite  difficult  to  bring  into  effect, 
especially  if  they  are  opposed  by  ancient  custom  as  well 
as  by  modern  fashion.  As  long  as  a  form  of  dress  is 
fashionable  it  is  difficult  to  induce  any  one  to  relinquish 
it,  no  matter  how  injurious  it  may  be  or  how  desirable 
the  change  from  a  hygienic  point  of  view. 

Cleanliness  in  Relation  to  Clothing. — The  excre- 
tions of  the  body  through  the  skin  are  absorbed  by  the 
clothing,  and  consequently  frequent  changes  should  be 
made  to  prevent  injurious  effects  from  the  accumulation 
of  these  products  in  the  clothing.  The  excretions  of  the 
body  fill  the  pores  of  the  clothing  and  render  it  more  im- 
pervious, and  therefore  less  suited  for  the  interchange 
of  air.  This  is  especially  the  case  in  those  engaged  in 
laborious  work,  where  the  amount  of  perspiration  is 
great. 

Starching  and  ironing  tend  to  close  the  pores  in  cloth- 
ing and  render  it  more  impervious.  The  wearing  of 
unstarched  clothing  in  hot  weather  is,  therefore,  more 
comfortable.  In  winter  starching  and  ironing  serve  to 
conserve  the  heat  of  the  body. 

The  amount  of  clothing  worn  must  be  varied  with  the 
season  of  the  year  and  the  sensations  of  each  individual. 
The  amount  of  clothing  necessary  to  conserve  the  heat 
of  the  body  of  one  person  may  be  entirely  too  light  or 
too  heavy  for  another.  The  changes  from  lighter  to 
heavier  clothing,  and  vice  versa,  should  not  be  made  too 
suddenly.  In  localities  where  there  is  a  variable  climate, 
with  frequent  changes  in  the  temperature  and  humidity 
of  the  atmosphere,  as  is  the  case  in  the  northern  States 
during  spring  and  autumn,  the  change  from  heavy  to 
light  clothing,  and  vice  versa,  must  be  made  with  great 
circumspection,  in  order  to  prevent  the  development  of 


CLEANLINESS  IN  RELATION  TO  CLOTHING.  247 

catarrhal  diseases.  The  changes  must  be  made  accord- 
ing to  the  idiosyncrasies  of  the  individual  and  the  season 
of  the  year.  The  change  can  never  be  regulated  by  the 
calendar,  because  the  conditions  vary  perceptibly  from 
year  to  year.  The  time  of  the  year  when  the  changes 
may  be  made  with  safety  must  frequently  become  a 
question  for  the  physician  to  decide  for  those  under  his 
care,  because  of  his  larger  experience  in  questions  of  this 
nature  on  account  of  prolonged  observation  and  study. 


CHAPTER   X. 
PERSONAL    HYGIENE. 

PERFECT  health  is  dependent  upon  the  normal  activity 
of  all  the  organs  of  the  body.  The  organic  functions  of 
the  body  can  be  maintained  in  their  normal  condition 
only  by  observing  all  the  general  hygienic  rules  and 
regulations.  These  principles,  while  they  are  well 
recognized  and  of  the  utmost  general  value,  cannot, 
however,  be  stated  in  very  specific  terms  when  applied 
to  individual  conditions,  because  the  individual  idiosyn- 
crasies of  different  persons  vary  to  such  a  great  extent. 

There  must  be  continuous  moderation  in  diet,  both 
with  regard  to  quality  and  quantity.  The  individual 
peculiarities  as  produced  by  inherited  and  acquired 
instincts  influence  the  quality  and  quantity  of  food  that 
are  most  suitable.  The  nature  and  amount  of  work  per- 
formed is  also  an  important  factor  in  the  matter  of  diet. 
So  also  are  the  temperature,  latitude,  and  altitude  of  a 
locality,  and  the  amount  and  nature  of  the  clothing 
worn.  Individual  experience,  therefore,  plays  a  most 
important  part  in  governing  the  diet  of  each  person. 
The  point  to  be  borne  in  mind  is  that  all  excesses  should 
be  avoided.  No  more  should  be  taken  than  the  system 
demands  and  can  conveniently  utilize.  If  this  point  is 
properly  regulated,  one  of  the  principal  factors  in  the  pro- 
duction of  disease  is  eliminated.  The  food  taken  should 
be  slowly  and  thoroughly  masticated.  This  will  favor 
the  admixture  of  a  plentiful  supply  of  saliva,  and  will 
also  facilitate  the  subsequent  steps  in  the  process  of 
digestion.  Proper  mastication  of  the  food  cannot  take 
place  without  sound  teeth.  Deficient  teeth  frequently 
lie  at  the  foundation  of  various  affections  of  the  stomach. 

248 


CLEANLINESS.  249 

The  supply  of  nitrogenous  and  carbonaceous  foods 
should  be  regulated  according  to  the  demands  of  the 
body.  If  there  is  a  deficiency  of  fatty  deposit,  the  supply 
of  carbohydrates  is  probably  insufficient;  on  the  other 
hand,  if  there  is  an  excess  of  fatty  deposit,  the  supply 
of  fats  and  carbohydrates  is  excessive.  These  are  points 
that  can  be  regulated  by  each  individual,  to  a  certain 
extent,  though  it  must  be  remembered  that  some  persons 
are  normally  fatter  or  thinner  than  others. 

Cleanliness  is  one  of  the  most  important  factors  in 
the  preservation  of  health.  This  applies  not  only  to 
cleanliness  of  the  body,  but  to  cleanliness  in  every  par- 
ticular of  life.  It  goes  without  saying  that  cleanliness 
of  body,  clothing,  and  habitation  is  essential  to  good 
health.  The  number  of  baths  taken,  and  the  kind  of 
bath,  is  a  matter  that  is  governed  by  individual  condi- 
tions, such  as  habit,  amount  and  character  of  the  work 
performed,  and  the  temperature  of  the  locality. 

Regular  attention  to  the  bowels  is  an  important 
matter  in  regulating  the  health.  The  number  of  move- 
ments  a  day  will  be  regulated  by  the  diet  and  habit  af 
each  individual,  though  it  is  generally  conceded  that  one 
movement  a  day  is  desirable  in  order  to  maintain  the 
efficiency  of  the  digestive  apparatus. 

The  regulation  of  the  passions  is  another  matter  for 
individual  control,  though  all  excesses  should  be  avoided. 
The  practice  of  vices  is  to  be  condemned  in  the  most 
forcible  manner  because  of  the  detrimental  influence  upon 
the  nervous  system  and  the  entire  organism.  Parkes 
states  that  "we  know  that  a  widespread  profligacy  has 
eaten  away  the  vigor  of  nations,  and  caused  the  downfall 
of  nations;  but  we  hardly  recognize  that,  in  a  less  degree, 
the  same  causes  are  active  among  us,  and  never  realize 
what  a  State  might  be  if  its  citizens  were  temperate  in 
all  things." 

Cleanliness  of  the  mouth  and  teeth  is  of  the  greatest 
importance.  Proper  care  of  the  teeth,  including  sys- 
tematic   cleansing,  will    go   far   to   preserve  them    in  a 


250  PERSONAL  HYGIENE. 

sound  condition.  This  will  also  serve  to  prevent  the 
accumulation  of  decaying  food  particles  around  the 
teeth  and  gums,  and  thus  prevent  the  decay  of  the  teeth 
and  disease  of  the  gums  and  of  the  mucous  membrane  of 
the  mouth  and  throat.  A  decaying  tooth  should  be  filled 
as  early  as  possible,  in  order  to  preserve  it  and  to  prevent 
more  serious  disease  of  the  maxillary  bone. 

Great  care  should  be  exercised  in  the  selection  of  a 
habitation.  The  nature  of  the  water-supply  is  an  impor- 
tant factor  in  the  preservation  of  health.  If  the  purity 
of  the  water-supply  is  doubtful,  it  will  be  the  wisest 
course  to  have  all  the  water  boiled.  The  nature  of  the 
soil  is  also  an  important  factor.  Damp  soils,  as  well  as 
recently  made  soils,  should  be  avoided,  because  they  may 
prove  injurious  to  health.  The  material  used  in  con- 
structing the  house  is  of  importance,  as  well  as  the  posi- 
tion of  the  house  with  reference  to  the  points  of  the  com- 
pass. A  southern  exposure  is  usually  preferable  to  a 
northern  exposure.  The  number  and  arrangement  of 
the  windows  should  be  considered.  There  should  be 
plenty  of  light  and  free  access  of  air.  Sunlight  is  the 
great  restorer  and  purifier,  and  it  should  be  freely  ad- 
mitted to  all  houses  when  the  temperature  will  permit. 

The  nature  of  the  occupation  and  its  influence  upon 
health  should  be  carefully  considered.  If  the  occupation 
selected  should  prove  detrimental  to  health,  it  should  be 
discarded  for  one  that  is  less  likely  to  operate  in  the  same 
manner.  If  a  sedentary  occupation  proves  harmful,  it 
should  give  way  to  another  involving  much  outdoor 
activity.  The  amount  of  mental  work  that  may  be  per- 
formed without  injuring  the  health  will  depend  upon  the 
individual  constitution.  A  sedentary  occupation  may  be 
prevented  from  injuring  the  health  by  the  employment 
of  systematic  exercise  of  some  form  or  another.  When- 
ever possible  the  occupation,  as  well  as  the  bodily  exer- 
cise, should  be  of  a  cheerful  nature.  The  exercise  in- 
dulged in  may  often  be  made  most  beneficial  by  taking  it 
in  conjunction  with  other  persons.      For  this  reason  the. 


MENTAL  ATTITUDE.  251 

different  athletic  sports  are  of  such  great  benefit.  If  out- 
door exercise  be  taken,  it  may  be  made  profitable  as  well 
as  pleasurable  by  combining  it  with  nature  studies. 
Under  such  conditions  the  exercise  is  not  so  likely  to 
become  burdensome,  because  one  loses  sight  of  the  feel- 
ing of  compulsion. 

The  mental  attitude  of  the  individual  is  also  an  impor- 
tant factor  in  preserving  health.  Hopefulness  and  cheer- 
fulness are  great  aids  to  health  because  of  their  beneficial 
influence  on  digestion.  The  mental  condition  is  largely 
under  the  control  of  the  will-power,  and  each  individual 
is  hopeful  and  cheerful  or  morose  and  despondent  as  he 
wills  to  be. 

The  regulation  of  work,  rest,  sleep,  and  meals  is  more 
or  less  under  individual  control.  The  amount  of  sleep 
required  for  perfect  refreshment  varies  with  the  indi- 
vidual. It  is  usually  greater  in  childhood  and  old  age 
than  in  the  prime  of  life.  The  amount  of  sleep  taken  in 
order  to  preserve  the  health  should  be  sufficient  to  prevent, 
if  possible,  a  feeling  of  sleepiness  during  the  day.  It  is 
generally  conceded  that  the  most  refreshing  sleep  is 
obtained  in  the  early  hours  of  the  night,  though  some 
persons  can  accustom  themselves  to  sleep  soundly  during 
any  portion  of  the  twenty-four  hours.  It  is  possible  to 
deprive  one's  self  of  sleep  for  a  considerable  time,  but 
eventually  the  effects  will  be  felt  in  loss  of  nervous 
power.  This  is  especially  the  case  with  those  engaged 
in  mental  work.  Sooner  or  later  a  period  of  insomnia 
supervenes  which  is  not  easily  overcome. 


CHAPTER   XI, 

INDUSTRIAL    HYGIENE. 

The  influence  of  occupation  upon  the  health  of  laborers 
is  a  subject  of  the  greatest  hygienic  importance.  Certain 
occupations  are  far  more  dangerous  than  others  because 
of  the  liability  to  accident;  some  occupations  are  more 
dangerous  than  others  because  of  poisonous  fumes  and 
gases  that  are  given  off  in  certain  manufacturing  proc- 
esses; again,  other  occupations  are  dangerous  to  health 
because  of  various  kinds  of  dusts  that  are  produced,  thus 
leading  to  irritation  of  the  respiratory  organs.  In  other 
occupations  certain  groups  of  muscles  and  certain  organs 
of  the  body  are  used  excessively,  thus  leading  to  defects 
in  these  organs;  while  in  others  a  constrained  attitude  is 
maintained  while  at  work,  or  a  sedentary  life  is  induced, 
which  may  be  the  cause  of  ill  health. 

The  occupations  which  are  directly  concerned  in  the 
production  of  disease  are  those  in  which  irritating  or 
poisonous  gases  are  produced,  such  as  sulphurous,  nitric, 
and  hydrochloric  acid  fumes;  ammonia,  chlorin,  carbon 
monoxid  and  dioxid,  hydrogen  sulphid  and  carbon  di- 
sulphid,  iodin,  bromin,  and  phosphorus  vapors;  turpen- 
tine and  petroleum  vapors;  mercury,  arsenic,  lead,  zinc, 
and  copper  poisoning;  aniline  vapors;  those  in  which 
irritating  or  poisonous  dusts  are  produced,  such  as  coal- 
dust,  metallic  dust  of  various  kinds,  mineral  dust,  and 
vegetable  dust;  those  in  which  there  is  local  absorption 
of  irritating  or  poisonous  substances,  such  as  arsenic, 
phosphorus,  quinin,  potassium  bichromate,  strong  alka- 
lies, and  petroleum;  those  in  which  there  is  an  elevated 
or  variable  temperature  and  atmospheric  pressure. 

Analyses   of    the   deaths   occurring    in    the   different 

252 


INDUSTRIAL  HYGIENE. 


253 


occupations  have  given  us  a  knowledge  of  the  relative 
degree  of  danger  from  different  forms  of  industrial  pur- 
suits. Such  an  analysis  has  been  made  of  all  the  deaths 
occurring  in  Massachusetts,  including  all  persons  over 
twenty  years  of  age,  from  May  1,  1843,  to  December  31, 
1885,  by  the  registration  bureau  of  that  State.  The  fol- 
lowing table  gives  the  detailed  results  of  .this  analysis. 
The  total  number  of  deaths  was  229,897,  and  the  average 
age  at  death  51.82  years  : 


Occupations. 


Class    I.      Cultivators    of 
the  earth  :  Farmers, 
gardeners,  etc. 
Class     II.        Active     me-1 
chanics  abroad.         j 

Brickmakers 

Carpenters  and  joiners    . 

Calkers  and  gravers     .    . 

Masons 

Millwrights 

Riggers 

Ship-carpenters     .    .    .    . 

Slaters  

Stone-cutters 

Tanners 

Class    III.      Active    me- ) 
chanics  in  shops.      j 

Bakers 

Blacksmiths    ...... 

Brewers 

Cabinet-makers      .... 

Calico-printers 

Cord-makers 

Carriage-makers     and") 
trimmers.  J 

Chair-makers 

Clothiers  

Confectioners 

Cooks 

Coopers 

Coppersmiths 

Curriers 

Cutlers      

Distillers      

Dyers 

Founders 

Furnace-men 

Glassblowers  and  glass-] 
makers.  J 

Gunsmiths 

Hatters 

Leather-dressers    .... 

Machinists 

Millers 

Musical  instrument) 
makers.  J 

Nail-makers 

Pail-  and  tub-makers   .    . 

Painters 


0    . 

ho 
CO     ■ 

u  c 

u  S 

qj  0 

tjcS 

£-a 

>  d 

£ 

< 

46,182 

66.29 

17.371 

51-34 

159 

49-71 

9,761 

55-o6 

281 

58.91 

2,889 

53-33 

188 

60.43 

237 

55-54 

1 ,3°5 

61.36 

J59 

41.69 

1,678 

41.22 

714 

52-73 

28,208 

48.  So 

7Si 

49.16 

3,615 

55-n 

63 

45-14 

1,250 

50.66 

16 

58.87 

52 

50.42 

479 

51.87 

234 

46.49 

119 

57-25 

171 

45-37 

243 

40.87 

1,299 

59.88 

150 

46.09 

95i 

45-79 

218 

42.01 

36 

58.78 

269 

48.65 

764 

44.82 

175 

46.28 

202 

41.61 

306 

50.35 

53° 

-  34-55 

354 

46.88 

3,76i 

43-47 

386 

58.69 

61 

49-25 

2  79 

45-75     i 

7 

41.86 

3,56i 

45-77    ,1 

Occupations. 


Paper-makers 

Piano-forte  makers  .    .    . 

Plumbers      

Potters      

Pump-  and  block-makers 

Reed-makers 

Rope-makers 

Tallow-chandlers  .... 

Tin-smiths 

Trunk-makers 

Upholsterers 

Weavers 

Wheelwrights 

Wood-turners 

Mechanics    (trade     notl 

specified).  j 

Class  IV.     Inactive   me-  I 

chanics  in  shops.      J 

Barbers 

Basket-makers 

Book-binders 

Brush-makers 

Carvers 

Cigar-makers      

Clock-  and  watch-makers 

Comb-makers 

Engravers 

Glass-cutters       

Harness-makers    .... 

Jewellers 

Operatives 

Printers 

Sail-makers 

Shoe-cutters 

Shoe-makers - 

Silversmiths     or    gold-1 

smiths.  J 

Tailors      

Tobacconists 

Whip-makers 

Wool-sorters 

Class     V.       No    special  1 

trades.  J" 

Laborers 

Servants 

Stevedores 

Watchmen 

Workmen    in    powder-  \ 

mills.  J 


463 
210 
303 
65 
124 


640 
78 
287 
971 
738 
154 

3,369 
28,459 

772 
109 
258 
96 
141 
306 


222 

200 

124 

676 

782 

4,662 

i,243 

310 

795 

14,802 

140 


143 

238 

43,7!6 

42,532 
624 

I23 

410 

27 


48.65 
48.30 
36.34 
58.02 
58.23 

45-94 
60.01 
56.75 
42.95 
40.38 
40.98 
44-65 
59-50 
49-54 
47-35 

45-43 

39-34 
60.32 
43-56 
47-36 
37.60 
39-78 
51-47 
54.09 
39-74 
44.40 
50.00 
41.62 
41.28 
40.58 

55-17 
47.06 

46-34 
48.59 
50.19 
50.41 
44-50 
48.92 

49.06 
49.16 
39-J5 
54-07 
53-13 

37-41 


254 


INDUSTRIAL  HYGIENE. 


Occupations. 


Class  VI.    Factors,  labor-  \ 

ing  abroad,  etc.         J 
Baggage-masters  .... 

Brakemen 

Butchers :    .    . 

Chimney-sweepers    .    .    . 

Drivers 

Drovers 

Engineers  and  firemen    . 

Expressmen 

Ferrymen 

Lighthouse-keepers  .    .    . 

Peddlers 

Sextons 

Soldiers 

Stablers    

Teamsters 

Weighers  and  gaugers 

Wharfingers 

Class  VII.     Employed  on  \ 

the  ocean.  J 

Fishermen 

Mariners 

Naval  officers 

Pilots 

Seamen 

Class   VIII.     Merchants, 

financiers,     agents, 

etc. 
Agents  ....'■... 

Bankers 

Bank  officers 

Boardinghouse-keepers   . 

Booksellers 

Brokers 

Clerks  and  bookkeepers  . 

Druggists   and   apothe-  "I 

caries.  J 

Gentlemen 

Grocers 

Innkeepers  ....... 

Manufacturers 


65 
s  a. 


10,776 

72 

509 


28 
1,170 


24 
770 
149 

2,926 
654 

2,370 

39 
33 

12,394 

965 

11 

90 

122 

11,206 

27,098 

752 
103 
243 
127 
104 
382 
6,449 
487 

!>993 

1,019 

734 

2,219 


39-36 

36.25 
27.12 
50.50 
34-5° 
40.36 

5!-32 

41-57 
44.18 
51.27 
60.24 
48.28 
60.01 
28.59 
44.66 
42.31 
57-72 
55.48 


44-37 
44.36 
52.82 
61.63 
48.76 


50.62 
59-73 
57-1° 
50.47 

54-75 
52.13 
36.35 
43.86 

68.87 
48.80 
51-63 
54-92 


Occupations. 


Merchants 

Newsdealers  or  carriers  . 
Railroad  agents  or  con-1 

ductors.  / 

Saloon-  and  restaurant-1 

keepers.  j 

Stove-dealers      

Telegraphers 

Traders 

Class    IX.      Professional} 
men.  j 

Actors 

Architects 

Artists 

Civil  engineers 

Clergymen 

Dentists 

Editors  and  reporters  .    . 
Judges  and  justices  .    .    . 

Lawyers 

Musicians 

Photographers 

Physicians 

Professors 

Public  officers     .... 
Sheriffs,  constables, and"! 

policemen.  j 

Students 

Surveyors 

Teachers 

Class.  X.     Females  .... 

Domestics 

Dress-makers 

Milliners       

Nurses      

Operatives 

Seamstresses 

Shoe-binders       

Straw-workers 

Tailoresses 

Teachers 

Telegraphers 


B  5 

3   O. 


6,200 
76 

561 

832 

26 

59 

4,732 

8,306 


71 

306 

188 

1,560 

*93 
187 
46 
1,017 
419 
66 


637 

407 

460 

125 

694 

7,387 

1,990 

595 

230 

291 

2,237 

476 

89 

123 

353 


>  « 
< 


56.45 
43-78 
41.28 


40.70 

47.46 
29.97 
50.39 
52.13 
42.18 
46.23 
45-41 
43-91 
60.31 

45-47 
46.50 
66.17 
56.41 
43-13 
43-79 
56.51 
58-44 
56.44 
52.30 

23.67 
54.10 
44.62 

39^9 
44.11 

42.35 
42.45 
62.62 
29.71 
47-25 
36.78 
35.08 
5I-71 
33-72 
27-39 


This  table  is  not  accurate  in  all  its  details,  and  also 
fails  to  present  the  relative  healthfulness  of  different  oc- 
cupations, because  persons  are  constantly  changing  from 
one  occupation  to  another.  It  shows,  however,  very 
clearly  the  relation  of  certain  occupations  to  longevity. 

Dr.  William  Ogle,  who  has  probably  given  more  at- 
tention to  this  subject  than  anyone  else,  in  a  paper  pre- 
sented to  the  Seventh  International  Congress  of  Hygiene, 
1891,  on  mortality  in  relation  to  occupation,  states  that 
"of  all  the  various  influences  that  tend  to  produce  dif- 
ferences of  mortality  in  different  parts  of  a  given  country, 
there  is  none  so  potent  as  the  character  of  the  prevailing 


INDUSTRIAL  HYGIENE.  255 

occupations."  He  states  further  that  "  the  only  method 
of  making  death-rates  that  can  be  safely  compared  with 
each  other  is  the  laborious  plan  of  calculating  the  death- 
rates  for  each  occupation  at  each  successive  age-period, 
and  then  applying  these  successive  death-rates  to  a  popu- 
lation with  precisely  the  same  age-distribution  in  each 
industry.  This  method,  indeed,  is  necessary,  not  only 
when  the  mortality  of  an  occupation  is  being  compared 
with  that  of  any  other,  but  generally  in  all  comparisons 
of  mortality,  as,  for  instance,  in  comparison  between  the 
mortalities  of  different  countries,  or  between  the  mortali- 
ties of  the  two  sexes.  It  is,  however,  a  method  which, 
owing  to  its  laboriousness,  is  rarely  used,  with  the  neces- 
sary consequence  that  many  very  erroneous  comparisons 
are  made." 

He  gives  the  mortality  in  different  industries  and  pro- 
fessions which  were  derived  from  a  comparison  between 
the  census  returns  of  England  for  1881  and  the  death- 
registers  for  the  three  years  1881,  '82,  and  '83.  The 
figures  relate  exclusively  to  males. 

The  lowest  death-rate  obtained  was  that  of  men  in  the 
clerical  profession,  and  for  the  sake  of  comparison  this  is 
taken  as  the  standard,  being  represented  by  100,  and  the 
death-rate  of  each  of  the  other  professions  or  industries  is 
represented  by  a  figure  proportionate  to  this  standard. 

Dr.  Ogle  classes  the  causes  of  high  mortality  under 
seven  general  headings: 

"  1.  Working  in  a  cramped  or  constrained  attitude, 
and  notably  in  such  an  attitude  as  cramps  the  chest  and 
interferes  with  the  action  of  the  heart  and  lungs. 

"2.  Exposure  to  the  action  of  special  poisonous  or 
irritating  substances,  such  as  phosphorus,  mercury,  lead, 
infected  hair  or  wool,  soot,  etc. 

"  3.   Excessive  work,  mental  or  physical. 

"4.  Working  in  confined  spaces  and  in  foul  and  over- 
heated air.  This  is  probably,  in  the  aggregate,  one  of 
the  most  destructive  agencies  in  operation,  because  of  the 
very  large  number  of  trades  that  are  exposed  to  it. 


256 


INDUSTRIAL  HYGIENE. 


Comparative  Mortality  of  Men,  Twenty-five  to  Sixty-five 
Years  of  Age,  in  Different  Occupations,  1881,  1882, 
and   1883. 


Occupation. 


Comparative 
mortality. 


Clergymen,  priests,  ministers      .    .  ioo 

Lawyers 152 

Medical  men 202 

Gardeners 108 

Farmers 1 14 

Agricultural  laborers 126 

Fishermen 143 

Commercial  clerks 1 79 

Commercial  travellers 171 

Innkeepers,  liquor  dealers      .    .    .  274 

Inn,  hotel  service 397 

Brewers 245 

Butchers 211 

Bakers 172 

Corn-millers 172 

Grocers 139 

Drapers 159 

Shopkeepers  generally 158 

Tailors      189 

Shoe-makers 166 

Hatters 192 

Printers •    .    .  193 

Book-binders 210 


Occupation. 


Comparative 
mortality. 


Builders,  masons,  bricklayers     .    .  174 

Carpenters,  joiners 148 

Cabinet-makers,  upholsterers      .    .  173 
Plumbers,  painters,  glaziers    .    .    .  216 

Blacksmiths 175 

Engine-,  machine-,  boiler-makers  .  155 

Silk  manufacture 152 

Wool,  worsted,  manufacture  .    .    .186 
Cotton  manufacture 196 

Cutlers,  scissor-makers 229 

Gunsmiths 186 

File-makers 300 

Paper-makers 129 

Glass-workers 214 

Earthenware-makers 314 

Coal-miners 160 

Cornish  miners 33 1 

Stone,  slate  quarries 202 

Cab,  omnibus  service 267 

Railway,  road,  laborers 185 

Costermongers,    hawkers,     street- 
sellers 338 


"  5.   Excessive  use  of  alcoholic  beverages. 

"6.   Liability  to  fatal  accident. 

"  7.   Exposure  to  inhalation  of  dust." 

Under  the  second  cause  Dr.  Ogle  gives  the  following 
table  of  the  comparative  mortality  from  lead-poisoning, 
based  on  the  death-register  for  1879-82,  in  males  over 
fifteen  years  of  age: 

File-makers 466  per  million  living. 

Painters,  plumbers,  glaziers 224       "  " 

Earthenware-makers 152       ''  " 

Gas-fitters 62       "  " 

Printers 27       "  " 

All  other  males 4       "  " 


INDUSTRIAL  HYGIENE. 


257 


Under  the  fourth  cause  he  gives  the  following  table, 
showing  the  effects  upon  the  lungs  alone,  though  the 
lungs  are  not  the  only  organs  affected  by  this  cause. 
Fishermen,  who  suffer  least  from  these  diseases,  are  taken 
as  the  standard,  and  the  mortality  for  this  occupation  is 
represented  as  100. 

Comparative  Mortality  from  Phthisis  and  Lung  Diseases 
of  Men  [Forty-five  to  Sixty-five  Years)  Working  in 
Pure  and  Vitiated  Air. 


Air. 

Occupation. 

f 

Diseases  01 
Phthisis.     '  respiratory 
organs . 

Phthisis  and   dis- 
eases of  the  respir- 
atory organs. 

r 

Pure  air 

I 

Fishermen    .... 

Farmers 

Gardeners    .... 
Agricultural  laborers 

55              45 
52              50 

61  56 

62  79 

IOO 
I02 
117 
I4I 

Confined  air        < 

Grocers 

Drapers    ... 

84               59 
152               65 

143 
217 

Highly  vitiated  f 
air                     \ 

144 
233 

94 
84 

238 
317 

Under  the  fifth  cause  he  gives  the  comparative  mor- 
tality from  various  diseases  of  liquor-dealers  and  men 
generally.  The  trade  most  exposed  to  the  effects  of  the 
excessive  use  of  alcohol  is  that  of  dealers  in  these  bev- 
erages—  "innkeepers,  publicans,  and  wine-  and  spirit- 
dealers."  The  table  shows  the  comparative  results  ob- 
tained by  taking  the  mortality  of  1000  males  of  cor- 
responding ages. 

Under  the  seventh  cause  he  gives  the  comparative 
mortality  from  phthisis  and  lung  diseases  in  the  various 
dust-inhaling  occupations.  The  effects  of  the  inhalation 
of  dust  are  shown  in  an  increased  mortality  from  phthisis 
and  from  lung  diseases,  though  the  effects  differ  very 
greatly,  not  only  with  the  amount  of  dust,  but  also  with 
the  character  of  the  dust,  the  more  irritating  the  dust 
the  more  injurious  its  effects. 
17 


258 


INDUSTRIAL  HYGIENE. 


Comparative  Mortality  of  Liquor-dealers  and  Men  gen- 
erally. 


Alcoholism 

Liver  diseases 

Gout 

Diseases  of  the  nervous  system  .    . 

Suicide       

Diseases  of  the  urinary  system  .  . 
Diseases  of  the  circulatory  system 
All  other  causes 

All  causes      ........ 


Men     twenty-five 

to 

sixty-fivs 

years 

oi 

age. 

Liquor  trade. 

All 

males. 

55 

IO 

240 

39 

13 

3 

200 

119 

26 

H 

83 

41 

140 

120 

764 

654 

1521 


Comparative   Mortality  from    Phthisis  and  Respiratory 
Diseases  of  Men  in  various  Dust-inhaling  Occupations. 


Men  twenty-five  to  sixty-five  years  of  age. 


Fishermen  (as  standard). 


T  ,•  I    Phthisis  and 

Lung  diseases.   ,  ,. 

a  lung  diseases. 


Carpenters,  joiners  .    .    .    . 

Bakers       

Wool-workers 

Cotton-workers 

Cutlers,  scissors-workers 

File-workers 

Masons,  bricklayers     .    .    . 
Stone  and  slate  quarrymen 

Pottery-makers 

Cornish  miners 

Coal-miners       


103 

107 
130 

137 

187 
219 
127 
156 

239 

348 
64 


67 

94 
104 

137 
196 
177 
102 

138 
326 
231 
102 


170 
201 

234 
274 

383 
396 
229 
294 
565 
579 
166 


"The  dust  of  ordinary  kinds  of  woods,  such  as  are 
commonly  used  by  carpenters  and  joiners,  appears  to  have 
very  little,  if  any,  injurious  effect  upon  the  air-passages, 
for  the  mortality  of  these  artisans,  both  from  phthisis  and 
from  diseases  of  the  respiratory  organs,  is  below  the 
average  for  males  generally.  The  harder  woods,  how- 
ever, such  as  are  used  by  cabinet-makers,  are  said  to 
give  off  a  much  more  injurious  dust  than  do  the  softer 
woods  used  by  carpenters." 


INDUSTRIAL  HYGIENE. 


259 


Sommerfeld  l  gives  the  results  of  a  detailed  study  of  the 
influence  of  occupations  without  and  with  the  formation 
of  dust.  His  calculations  are  based  on  the  results  ob- 
tained in  thirty-eight  Berlin  hospitals.  During  the  time 
over  which  the  investigation  extended  there  were  906,341 
patients  in  these  hospitals,  of  which  number  9761  died. 
Of  the  deaths,  5449  resulted  from  diseases  of  the  respira- 
tory organs,  of  which  number  4675  were  due  to  tuber- 
culosis. 

If  the  occupations  are  divided  into  those  without  and 
those  with  dust,  we  find  marked  differences.  In  the  first 
group  the  death-rate  from  tuberculosis  is  2.39  per  1000; 
in  the  second  group,  5.42  per  1000;  of  1000  deaths,  there 
were  in  the  first  group  381  from  tuberculosis,  in  the  sec- 
ond, 480.  If  these  results  are  compared  with  the  condi- 
tions among  adult  males  in  Berlin,  over  fifteen  years  of 
age,  we  find  that  the  laborers  in  occupations  in  which 
there  is  formation  of  dust  are  affected  not  very  much 
more  unfavorably  than  the  average,  the  laborers  in  the 
occupations  without  dust-formation  far  more  favorably. 


Of  iooo  living, 
there  died  of 
tuberculosis — 

Of  1000  deaths, 
there  were  from 
tuberculosis — 

2-39 

5-42 

381.O 
4S0.O 

Occupations  with  formation  of — 

1.   Metallic  dust .    .    . 

5-84 
5-3i 
5-55 
7-79 
5-64 
4-42 

470.58 

520.5 

4037 
501.0 

537-04 
403-43 

5.16 

478.9 

Adult  males   of  Berlin  of  same   age,  1 
general  population.                                J 

4-93 

332-3 

Among  the  occupations  in  which  there  is  mineral  dust, 
stone-cutters    and    workers    in   glass   and   porcelain    are 

1  Hygienische  Rundschau,  Jahrg.  vii.,  S.  44. 


260  INDUSTRIAL  HYGIENE. 

excluded.  When  we  include  these  the  table  is  changed 
in  that  the  occupations  with  mineral  dust  assume  the 
first  place.  Of  1358  stone-cutters,  distributed  among  ten 
places,  Sommerfeld  found  61  deaths,  indicating  a  death- 
rate  of  39  per  1000;  of  497  deaths,  444  were  due  to 
tuberculosis  =  893.3  per  1000.  Among  workers  in  glass 
the  death-rate  from  tuberculosis  was  375  per  1000;  among 
glass-grinders,  500  per  1000;  and  among  workers  in 
porcelain,   600  per   1000. 

N  great  deal  has  been  accomplished  in  recent  years  in 
preventing  the  detrimental  influence  of  the  different  irri- 
tating and  poisonous  gases  and  fumes  evolved  in  certain 
manufacturing  processes.  The  employment  of  special 
ventilating  flues  and  hoods  to  remove  the  poisonous 
gases  obviates,  to  a  large  extent,  the  danger  from  such 
gases,  and  has  rendered  these  occupations  far  more 
healthful. 

In  the  mechanical  trades,  where  irritating  dusts  are 
most  frequently  encountered,  there  has  also  been  great 
improvement  through  the  introduction  of  special  ap- 
pliances around  each  machine,  whereby  the  dust  is 
exhausted  from  the  work-room  at  the  point  of  produc- 
tion, though  it  is  impossible  to  remove  these  dusts  en- 
tirely. In  the  grinding  of  metals  the  formation  of  dust 
has  been  greatly  diminished  in  many  localities  by  the 
prohibition  of  dry  grinding. 

Moritz  and  Ropke l  report  upon  a  detailed  study  of  the 
hygienic  condition  of  the  metal-grinders  of  Solingen, 
Germany.  The  death-rate  among  the  grinders  from 
1885  to  1895  was  20.6  per  cent.,  as  compared  with  only 
13.6  per  cent,  for  the  remainder  of  the  population.  Of 
100  deaths  in  men  over  fourteen  years  of  age  during  the 
same  time,  72.5  per  cent,  of  the  deaths  among  the 
grinders  were  due  to  tuberculosis;  among  the  remainder 
of  the  population,  only  35.5  per  cent.  On  examination 
of  the  grinders,  only  16  per  cent,  were  found  to  be 
healthy;  5.7  percent,  complained,  but  in  these  no  disease 

1  Zeitschrift  f.  Hygiene,  Bel.   xxxi.,  S.  231. 


INDUSTRIAL  HYGIENE.  261 

was  found;  and  78.3  per  cent,  were  diseased.  Of  those 
over  forty-five  years  of  age,  none  were  found  that  were 
healthy. 

Moritz  and  Ropke  state  that  the  dust  produces  an  irri- 
tation of  the  mucous  membrane  of  the  nose,  resulting  in 
the  formation  of  boils.  There  are  also  a  cutaneous  erup- 
tion and  a  swelling  of  the  nose.  Later,  a  certain  degree 
of  tolerance  is  established,  but  the  mucous  membrane  of 
the  nose  becomes  atrophic.  This  condition  was  found  in 
23.2  per  cent,  of  the  workmen,  as  compared  with  12.2 
percent,  in  the  remainder  of  the  population.  32.2  per 
cent,  suffered  from  chronic  nasal  catarrh,  48.2  per  cent, 
from  catarrh  of  the  pharynx,  and  12  per  cent,  had  disease 
of  the  chest.  The  feeling  of  dryness  of  the  throat  leads 
to  the  consumption  of  large  amounts  of  fluid.  The 
effects  of  the  excessive  use  of  alcoholic  beverages  was 
shown  in  11  per  cent,  with  fatty  heart,  and  5.4  per  cent, 
with  fatty  liver.  Rheumatic  affections  were  found  in  4.4 
per  cent. 

The  authors  state  that  in  order  to  prevent  the  forma- 
tion of  dust  wet-grinding  is  to  be  recommended  wher- 
ever possible.  For  the  removal  of  dust  from  the  point 
of  production,  ventilation  apparatus  of  special  construc- 
tion must  be  used;  but,  since  even  with  the  most  perfect 
dust-exhaustion  apparatus  the  penetration  of  dust  into 
the  work-room  is  not  entirely  prevented,  it  is  necessary 
to  remove  the  dust  deposited  on  the  surfaces  in  the  room 
as  frequently  as  possible. 

The  grinders  must  exercise  the  greatest  degree  of 
cleanliness,  not  only  of  the  work-room,  but  also  of  their 
persons,  and  the  introduction  of  shower-baths  into  new 
establishments  is  desirable. 

In  order  to  protect  the  health  of  the  grinders  from  the 
highly  injurious  effects  of  the  dust,  they  should  be  re- 
quired to  breathe  through  the  nose,  and  assume  an 
upright  position  as  much  as  possible. 

The  reduction  of  the  number  of  working-hours  is  also 
recommended,  and  the  observation  of  pauses  about   the 


262  INDUSTRIAL  HYGIENE. 

middle  of  the  forenoon  and  afternoon  to  permit  the  work- 
men to  spend  a  short  time  in  an  atmosphere  free  from 
dust.  A  ten-hour  day  for  adults,  and  an  eight-hour  day 
for  vouths,  are  considered  the  maximum. 

The  following  regulations  were  passed  in  1883  con- 
cerning establishments  in  which  metal  goods  are  ground 
and  polished:  The  work-rooms  of  all  new  establishments 
erected,  or  of  extensions  of  old  establishments,  must 
have  a  height  of  at  least  3.5  meters,  the  windows  must 
have  at  least  one-twelfth  the  floor  surface,  and  each 
person  must  be  supplied  with  16  cubic  meters  of  air 
space.  The  floors  must  be  tight,  and  the  walls  must  be 
freshly  painted  or  whitewashed  at  least  once  a  year. 
Clay  floors  in  new  establishments  or  extensions  are  pro- 
hibited. 

Shuler  has  made  a  detailed  study  of  the  hygienic  con- 
dition of  the  millers  of  Switzerland.1  He  studied  the 
sick  lists  of  hospitals,  and  gives  an  analysis  of  108  cases. 
These  were: 

Diseases  of  the  digestive  organs .17 

Diseases  of  the  respiratory  organs 34 

Diseases  of  the  circulatory  organs 3 

Tuberculosis 12 

Rheumatism 19 

Diseases  of  the  eyes 4 

Diseases  of  the  skin 19 

Under  the  diseases  of  the  respiratory  organs  there  were 
8  cases  of  pneumonia  and  pleurisy,  and  under  the  dis- 
eases of  the  skin  there  were  6  cases  of  itch  and  pedicu- 
losis, and  3  of  eczema. 

Shuler  states  that  if  we  take  certain  disease-groups 
into  consideration,  we  find  in  iooo  workmen  the  number 
suffering  from  diseases  of  the  respiratory  organs  dis- 
tributed as  follows:  Millers,  42.3;  cotton-spinners,  47.7; 
embroiderers,  70.7;  and  workmen  in  mechanical  establish- 
ments, 76.8.  The  number  suffering  from  diseases  of  the 
skin  are  distributed  as  follows:  Millers,  10.2;  cotton- 
spinners,  16.5;  embroiderers,  24.2;  and  mechanics,  32.8. 

1  Deutsche  Vierteljahr.  f.  oeffentliche  Gesundheilspflege,  Bd.  xxix.,  S.  513. 


INDUSTRIAL  HYGIENE. 


263 


The  millers,  who  in  1888  numbered  5412,  had,  in  the 
years  1883  and  1884,  1388  deaths,  at  the  following  ages: 


Age. 


Total    .    .    .    . 
Tuberculosis 


^  ' 

>. 

V 

S 

" 

>i 

> 

■g 

2  «j 

,o 

>> 

«3 

X 

0  .= 

c  C 

>.'~ 

>,S 

2U- 

O    u" 

^    D* 

>>  1 

0>    ZJ 

5    >> 

5  " 

>..z 

>-.-= 

i9-> 

ta 

H 

H 

fa 

fa 

w 

ir. 

267 

24 

85 

110 

200 

320 

360 

6 

29 

46 

59 

63 

26 

8 

Of  the  millers,  16  per  cent,  died  of  pulmonary  tuber- 
culosis, while  in  the  same  years  for  the  total  population 
of  the  cities  of  Switzerland,  with  over  10,000  inhabitants, 
only  14.4  per  cent,  died  of  the  same  disease.  The  death- 
rate  from  tuberculosis  in  the  cities  is  2.95  per  1000,  while 
among  millers  it  is  3.65  per  1000. 

In  the  report  of  Dr.  Kummer,  formerly  Chief  of  the 
Statistical  Bureau,  in  Berti  lion's  Encyclopedia  of  Hygiene, 
on  the  death-rate  from  tuberculosis  in  Switzerland  for  the 
years  1879  to  1882,  the  rate  is  given  for  a  number  of 
different  occupations.  In  1895  Dr.  Crevoisier  reported 
on  the  same  subject  in  the  Swiss  statistical  Zeitschrift 
based  on  material  of  the  statistical  bureau  for  the  years 
1881  to  1890.  These  reports  differ  as  to  the  general 
death-rate  from  tuberculosis,  but  coincide  fairly  well  as 
to  the  death-rate  from  this  disease  for  the  different  trades. 


According  to  Kummer 
Landlords    .    . 
Textile-workers 
Laborers  (indoors) 
Millers     .    . 
Masons     .    . 
Shoemakers 
Machinists  . 
Butchers  .    . 
Bakers     .    . 
Tailors     .    . 
Carpenters  . 
Book-printers 
Locksmiths 
Stone-cutters 


i-37 

2.14 
2.5S 
2.70 
2.74 
2.90 
2.96 
3H 
3-33 
3-34 
3-40 

3-65 
4.88 
6.87 


According  to  Crevoisier. 

Landlords I  80 

Cotton-weavers 2. 15 

Laborers  (indoors) 3. 10 

Millers 3.50 

Bakers 3.70 

Silk-weavers    ....        ....  3.70 

Masons 3.80 

Shoe-makers 4.00 

Machinists 4.20 

Dyers  and  Printers 4-7° 

Carpenters  .    .        4-7° 

Book-printers  and  Lithographers  .  6.60 

Locksmiths 7.01 

Stone-cutters 8.00 


264 


INDUSTRIAL  HYGIENE. 


The  danger  from  accidents  varies  in  the  different  trades 
and  occupations.  The  Swiss  Secretary  of  Labor  states 
that  anions;  1000  laborers  accidents  occur  as  follows: 


Cotton-spinners 22.2 

Millers 28.0 

Paper-manufacturing 31. 1 

Carpenters 35.2 

Locksmiths 46.9 


Brewers 66.7 

Masons       80.5 

Smiths 93.I 

Metal-turners 102. 1 

Moulders 1324 


Influence  of  the  length  of  the  Working-day  on 
the  Health  of  the  X,aborers. — Dr.  E.  Roth,1  in  a  paper 
on  this  subject,  makes  the  following  statements  : 

"  1.  The  length  of  the  working-day  must  be  shorter 
the  greater  the  amount  of  mental  or  physical  energy  re- 
quired, or  the  greater  the  danger  from  the  industrial  oc- 
cupation. 

"  2.  The  length  of  the  working-period  must  be  shorter 
the  less  developed  and  the  less  resistant  the  organism  of 
the  laborer. 

"3.  Women  and  youths  must  be  excluded  from  all 
work  in  which  great  physical  energy  is  required  ;  also 
from  industries  in  which  their  health  may  be  affected 
by  the  action  of  poisonous  substances  or  dust,  or  which 
require  special  and  continued  attention. 

"4.  Laborers  of  eighteen  years  of  age  are  to  be  in- 
cluded in  the  protected  class  of  fourteen  to  sixteen  years 
of  aofe. 


direct  effect  upon  the  mental  or  physical  condition,  and 
is  not  accompanied  with  particular  danger  from  accident, 
the  length  of  day  must  not  exceed  a  definite  number  of 
hours. 

"  If  a  universal  maximum  is  to  be  established,  then  a 
ten-hour  working-day  may  be  established  in  general  when 
the  existing  conditions  are  favorable,  and  a  longer  work- 
ing-period may  not  be  allowed  either  in  the  interest  of 
the    laborers   or   their   employers.      Exception   must    be 

1  Deutsche  Vierteljahr,  f.  oeffentliche  Gesimdheitspflege ,  Bd.  xxvii.,  S.  277- 


LIGHTING  OF  INDUSTRIAL  ESTABLISHMENTS.  265 


made  in  those  occupations  in  which  no  definite  working- 
day  can  be  established. 

The  following  tables  do  not  indicate  any  marked  de- 
crease in  the  number  of  sick-days  per  laborer  after  a  re- 
duction in  the  length  of  the  working-day  from  nine  to 
eight  hours  : 

Male  Laborers. 


Length  of 

Average 

Number  of 

Number 

Per  cent. 

Sick-days 

Year. 

working- 

number 

working- 

of  sick- 

of  work- 

per 

day. 

working. 

days. 

days. 

ing-days. 

laborer. 

1889 

9  hours. 

114 

35,568 

726 

2.04 

6-37 

1890 

9       " 

141 

43,992 

808 

1.84 

5-73 

1891 

9       " 

116 

36,192 

478 

1.32 

4-i 

1892 

8      " 

97 

30,264 

256 

0.84 

2.64 

J  8  hours  after 
\     April  1. 

1893 

8       " 

105 

32,760 

660 

2.01 

6.2. 

Female 

Labor 

ers. 

Length  of 

Average 

Number  of 

Number 

Per  cent. 

Sick-days 

Year. 

working- 

number 

working- 

of  sick- 

of  work- 

per 

day. 

working. 

days. 

days. 

ing-days. 

laborer. 

1889 

9  hours. 

225 

70,200 

1286 

1.83 

5-7i 

1890 

9       " 

236 

73,632 

1942 

2.63 

8.2 

1891 

9 

247 

77,064 

1007 

1.30 

4.08 

1892 

8       " 

230 

71,760 

1205 

1. 61 

5-2 

J"  8  hours  after 

1^93 

8      " 

204 

63,684 

1404 

2.20 

6.9 

"6.  The  system  of  working  overtime  should  be 
earnestly  discouraged. 

"  7.  For  youthful  workers  a  forenoon  and  an  afternoon 
pause  are  necessary  aside  from  the  midday  intermission. 

"  For  adult  laborers  these  special  pauses  are  required 
when  the  midday  pause  is  only  one  hour,  and  when  the 
working  period  of  the  forenoon  and  afternoon  exceeds 
four  hours,  or  the  total  working-day  exceeds  eight  hours. ' ' 

lighting  of  Industrial  Establishments.  —  The 
hygienic  requirements  in  the  artificial  lighting  of  indus- 
trial establishments  are  given  very  succinctly  by  Eris- 
mann,  in  a  paper  on  "Artificial  Lighting,  with  Special 
Reference  to  Distribution  of  Light,"1  in  which  he 
states  that:  "Hygiene  makes  the  following  demands  on 
the  lighting  technic: 

1  Deutsche  Vierteljahr.  f.  oeffentliche  Gesundheitspjlege,  Bd.  xxxii.,  S.  II. 


266  INDUSTRIAL  HYGIENE. 

"  i.  The  quantity  of  light  falling  upon  each  work- 
place— the  so-called  degree  of  light — as  well  as  the 
brightness  of  the  surface,  must  be  sufficiently  great. 
For  coarser  work  on  good  reflecting  surfaces  10  meter- 
candles  are  sufficient;  for  finer  work  and  with  unfavorable 
reflection  conditions,  on  the  other  hand,  at  least  25  to  30 
meter-candles  are  required.  The  quantity  of  light  is  to 
be  measured  photometrically. 

"  2.  The  pollution  of  the  air  by  the  products  of  com- 
plete or  incomplete  combustion  of  the  illuminating- 
material  shall  be  as  low  as  possible.  The  purity  of  the 
illuminating-material  must  be  insisted  upon.  And  since 
with  the  increased  amount  consumed  the  absolute  quan- 
tity of  the  combustion-point  is  increased,  under  like 
conditions  that  form  of  illumination  is  to  be  desired  in 
which  the  total  consumption  of  illuminating-material 
per  degree  of  light  is  lowest. 

"  3.  Artificial  lighting  must  not  produce  any  percepti- 
ble increase  in  the  temperature  of  the  illuminated  room; 
therefore  the  heating  effect  of  the  source  of  light  must 
be  as  low  as  possible.  In  systems  of  illumination  in  which 
large  quantities  of  hot  combustible  gases  are  produced, 
these  must  be  efficiently  removed.  To  lessen  the  heat- 
production  through  hot  gases,  it  is  important  that  as 
large  an  amount  as  possible  of  the  energy  produced  is 
converted  into  light,  and  in  consequence  that  the  con- 
sumption of  illuminating-material  in  proportion  to  the 
brightness  of  the  flame  is  as  low  as  possible. 

"4.  The  heat-rays  of  the  source  of  light  must  not 
produce  any  discomfort.  The  discomfort  can  be  di- 
minished by  increasing  the  distance  between  the  heated 
body  and  the  persons  in  the  room.  Since,  however,  the 
amount  of  light  is  rapidly  diminished  by  this  means,  the 
conditions  for  diminishing  the  discomfort  from  heat-rays 
must  be  sought  in  the  system  of  illumination  itself; 
therefore  such  sources  of  light  are  to  be  selected  in  which 
the  caloric  equivalent  of  the  non-luminous  portion  of  the 
flame  is  as    low  as    possible.     The  construction   of  the 


LIGHTING  OF  INDUSTRIAL  ESTABLISHMENTS.  267 

burners  or  the  lighting  apparatus  must  be  of  such  a  na- 
ture that  the  lowest  possible  radiating  effect  is  obtained. 
As  the  best  source  of  light,  other  conditions  being  the 
same,  must  be  considered  that  in  which  the  heat-radia- 
tion per  candle-power  of  light  is  the  lowest.  The  heat- 
radiation  of  an  ideal  source  of  light  should  be  extremely 
small.  From  this  standpoint  the  color  of  the  light  is  not 
without  significance,  since  a  light  which  possesses  many 
red  rays  indicates,  in  general,  a  high,  and  a  light  with 
principally  green  and  blue,  on  the  other  hand,  a  low 
heat-radiation. 

"5.  Sources  of  light  that  possess  a  high  reflecting 
power,  in  which  a  large  amount  of  light  falls  upon  a  unit 
of  surface,  must  be  shaded  from  the  eyes  or  weakened  in 
some  way. 

u  6.  Flickering  of  the  source  of  light  and  decrease  in 
the  intensity  of  the  light  are  to  be  prevented  in  the  illu- 
mination of  rooms.  A  uniform,  steady  light  is  every- 
where to  be  desired,  and  is  absolutely  necessary  where 
work  is  carried  on  in  which  the  eyes  are  used  for  a  long 
time,  or  to  a  large  extent  (school-rooms,  certain  factories, 
etc.). 

"7.  The  dangers — poisoning,  explosion,  fire,  electric 
shock — to  which  the  consumers  or  the  public  is  exposed 
in  general  through  installation  or  conduction  of  illu- 
minating-arrangements, shall  be  as  small  as  possi- 
ble. 

"8.  Of  not  less  importance,  and  for  certain  rooms 
(school)  of  more  importance  than  the  supplying  of  as 
large  a  quantity  of  light  as  possible,  are  the  uniform  dis- 
tribution of  the  light  and  the  reduction  of  shadow-pro- 
duction. This  requirement  can  be  fulfilled  in  direct 
illumination  only  under  especial  circumstances.  The 
end  is  most  simply  and  surely  attained  by  the  use  of  indi- 
rect (electric)  light.  For  school-rooms  this  is  the  only 
mode  of  illumination  which  meets  all  the  hygienic 
requirements.  It  can  also  yield  very  good  results  in 
factories.     The  discomfort  from  heat-radiation  is  entirely 


268  INDUSTRIAL  HYGIENE. 

removed,  because  the  source  of  light  is  raised  high  above 
the  heads  of  the  occupants. 

"A  combination  of  direct  light  with  indirect,  by 
means  of  white-glass  reflectors,  is  not  to  be  recom- 
mended where  there  is  shadow-formation  (as  in  writing), 
and  metal  reflectors  are  to  be  preferred." 


CHAPTER   XII. 
SCHOOL  HYGIENE. 

Such  a  large  proportion  of  the  ill  health  of  a  com- 
munity is  found  in  children  of  school  age,  and  since 
such  a  large  percentage  of  this  ill  health  can  be  pre- 
vented, it  is  necessary  to  treat  briefly  the  subject  of 
school  hygiene. 

Site,  or  location,  with  Reference  to  Drainage 
Capacity  of  the  Soil. — In  school  architecture  a  ques- 
tion of  primary  importance,  the  consideration  of  which 
is  frequently  neglected,  is  that  of  location  with  regard  to 
the  nature  of  the  soil  and  its  drainage  capacity.  Satis- 
factory sanitary  arrangements  can  rarely  be  secured  in 
any  building  unless  the  site  of  the  building  is  carefully 
selected  with  regard  to  the  drainage  capacity  of  the  soil. 
The  soil  structure  as  regards  the  preponderance  of  defin- 
ite-sized grains,  coarse  or  fine,  influences  the  drainage 
capacity,  and  consequently  the  healthfulness  of  the  site. 
The  amount  of  slope  and  the  proximity  of  streams, 
either  surface  or  underground,  also  influence  the  char- 
acter of  the  soil.  For  these  reasons  it  is  of  primary 
importance  that  the  site  selected  for  a  school-building 
shall  be  of  such  a  nature  as  to  afford  the  very  best  facili- 
ties for  drainage,  not  only  for  refuse  and  excreta  collected 
in  the  building,  but  for  surface-  and  rain-water  flowing 
over  the  soil.  Whenever  the  soil  of  the  site  is  not  per- 
fectly dry,  it  should  first  be  underdrained. 

Parkes  states  that  the  conditions  which  insure  healthy 
habitations  are: 

i.  A  site  that  is  dry  and  not  malarious,  and  an  aspect 
which  gives  light  and  cheerfulness. 

2.   A  pure  supply  and    proper   removal  of  water,  by 

269 


2  JO  SCHOOL  HYGIENE. 

means  of  which  perfect  cleanliness  of  all  parts  of  the 
house  can  be  secured. 

3.  A  system  of  immediate  and  perfect  sewage  removal, 
which  renders  it  impossible  that  the  air  or  water  shall  be 
contaminated  from  excreta. 

4.  A  system  of  ventilation  which  carries  off  all  respira- 
tory impurities. 

5.  A  condition  of  house  construction  which  insures 
perfect  dryness  of  the  foundation,  walls,  and  roof. 

Structure  of  Walls. — Having  selected  a  proper  site 
for  the  building,  the  nature  of  the  building  is  of  consid- 
erable importance.  The  building  itself  should  be  de- 
tached, so  as  to  obtain  an  abundant  supply  of  fresh  air 
and  the  greatest  amount  of  light.  The  character  of  the 
materials  composing  the  walls  and  the  thickness  of  the 
walls,  the  number  of  layers  composing  them,  all  have  an 
important  influence  on  the  character  of  the  building. 
The  walls  should  be  rendered  impervious  to  moisture, 
and  it  is  preferable,  therefore,  to  have  double  walls  with 
an  air  space  between  the  inner  and  outer  surface.  The 
materials  employed  in  constructing  the  walls  will  be  gov- 
erned by  circumstances,  and  their  nature  is  not  of  great 
importance  if  they  are  properly  used.  Stone  walls  are 
usually  somewhat  damp,  but  can  be  rendered  perfectly 
dry  by  allowing  an  air  space  between  the  inner  and  outer 
layers. 

Cubic  Space  and  Floor  Space.— Cubic  Space.— From 
calcinations  made  by  Prof.  Parkes  and  Dr.  de  Chaumont, 
the  amount  of  air  required  for  each  adult  per  hour,  in 
order  to  maintain  a  certain  degree  of  purity  in  the  atmos- 
phere, is  85  cubic  meters.  The  respiratory  impurity 
added  to  the  air  will,  of  course,  be  less  with  children  than 
adults,  consequently  the  amount  of  air  required  to  main- 
tain the  standard  of  purity  will  be  less.  Though  children 
evolve  less  carbon  dioxid  in  a  given  time  than  adults,  yet 
relatively  for  their  body-weight  they  expire  more.  In 
fixing  a  standard  for  schools,  the  age  of  the  children 
ousfht  also  to  be  considered  ;  the  average  amount  of  air  re- 


CUBIC  SPACE  AND  FLOOR  SPACE.  271 

quired  being  about  55  cubic  meters  per  hour.  Parkes  says 
that  it  is  highly  desirable  that  some  general  agreement 
should  be  arrived  at  as  to  the  amount  of  air  necessary, 
even  if  it  be  admitted  that  the  desired  amount  cannot 
always  be  obtained.  If  we  adopt  the  following  amounts 
of  carbon  dioxid  as  being  evolved  during  an  hour  in 
repose,  we  shall  not  be  far  from  the  probable  truth: 

Adult  males  .  (say  70  kilograms  weight),  0.72  cubic  foot  =r  20        liters. 
Adult  females  (  "    51         "  "        ),  0.6  "        =17  " 

Children     .    .  (   "    35  "  "        ),  0.4  "         =  II. 25     " 

Average  of  a  mixed  assembly      ....    0.6  "         =  T7  " 

The  amount  of  fresh  air  that  must  be  supplied  in  order 
to  prevent  the  impurity  due  to  products  of  respiration 
exceeding  a  particular  limit,  is  measured  by  the  quantity 
of  carbon  dioxid  present  in  excess  over  that  in  external 
air,  according  to  either  of  the  standards  in  use,  and  may 

be  calculated  from  the  formula  -=d,   where  e  =  amount 

r 

of  carbon   dioxid    expired    in    liters  per  head  per  hour; 

r  =  admissible  limit  of  carbon  dioxid  due  to  respiratory 

impurity,   stated  per  liter;  d=  delivery  of  fresh  air  per 

head  in  cubic  meters. 

Under  these  conditions  the  amount  of  fresh  air  to  be 

supplied  in  health  during  repose  ought  to  be: 


For  adult  males     3600  cubic  feet  per  head  per  hour 

=  102 

cubic  meters. 

For  adult  females  3000          "              "                 " 

=     85 

(t         a 

For  children  .    .    2000          "              "                 " 

=    57 

" 

For      a      mixed 

assembly     .        3000          "              "                 " 

=    85 

U                    i( 

The  law  of  Massachusetts  requires  that  each  occupant  of 
a  school-room  receive  a  quota  of  850  liters  of -air  per  minute. 
If  this  is  taken  as  the  basis  for  the  minimum  amount  of 
air  required  by  each  child,  and  we  require  further  that 
the  air  be  changed  but  three  times  each  hour,  then  the 
minimum  amount  of  cubic  space  allowable  for  each  child 
is  17  cubic  meters.  This  is  slightly  lower  than  the  theo- 
retical amount,  as  shown  by  the  calculations  of  Parkes, 


2/2  SCHOOL  HYGIENE. 

but  it  is  far  in  excess  of  the  amount  of  space  usually  sup- 
plied in  common  schools. 

When  the  air  of  a  room  is  changed  more  frequently 
than  three  times  an  hour,  there  is  always  more  or  less 
draft  in  some  portions  of  the  room,  and  for  this  reason 
the  minimum  amount  of  space  allowed  should  be  ij 
cubic  meters.  Even  with  this  amount  of  cubic  space 
it  is  impossible  to  keep  the  air  of  rooms  of  the  same 
purity  as  outside  air,  owing  to  the  gases  given  off  during 
respiration.  For  this  reason  a  certain  amount  of  respir- 
atory impurity,  as  it  is  called,  is  permissible  in  well- 
ventilated  rooms.  With  the  outside  air  containing  4  parts 
in  10, 000  of  carbon  dioxid,  the  additional  amount  permiss- 
ible as  coming  from  respiration  is  2  parts  in  10,000,  making 
a  total  amount  of  carbon  dioxid  in  the  air  of  6  parts  in 
10,000.  It  should  be  our  aim  in  the  ventilation  of  school- 
rooms to  maintain  the  respiratory  impurity  at  this  low 
standard,  and  this  it  is  possible  to  do  if  the  initial  cubic 
space  is  sufficient — say  17  cubic  meters — and  we  have 
reliable  mechanical  means  for  introducing  the  requisite 
amount  of  fresh  air  each  hour.  If  the  cubic  space  is  less, 
or  the  arrangements  for  the  introduction  of  fresh  air  are 
imperfect,  it  is  impossible  to  have  perfect  ventilation  and 
pure  air.  It  is,  therefore,  merely  a  matter  of  choice  on 
our  part  whether  we  will  elect  to  have  efficient  ventilation 
or  not.  It  can  be  obtained  by  making  the  necessary 
expenditure.     Without  this  it  is  impossible  to  obtain  it. 

Floor  Space. — Each  child  should  have  a  floor  space  of 
at  least  4.25  square  meters.  This  amount  of  floor  space, 
when  the  height  of  the  room  is  4  meters,  will  give  each 
child  a  minimum  cubic  space  of  17  cubic  meters.  The 
amount  of  floor  space  is  an  important  factor,  inasmuch 
as  it  is  brought  into  relation  with  the  height  of  the 
room. 

Relation  of  Window  Space  to  Cubic  Space. — In 
fixing  the  height  of  stories,  when  not  governed  by  the 
amount  to  be  expended,  the  height  of  the  basement 
should  be  2.8  to  3  meters.       The  first    story  should  be 


LIGHTING.  273 

3.9  and  the  second  story  3.8  meters  in  height.  Light  in 
rooms  of  the  second  story  is  always  superior  to  that  of  the 
first,  consequently  the  increased  height  of  the  first  story. 
There  is  also  usually  an  increase  of  glass  surface  pro- 
vided for  the  first  story  to  equalize  the  difference  in  light. 
The  window  heads  should  be  finished  to  the  top,  so  that 
no  shadow  can  be  thrown  on  the  ceiling.  The  sills  of 
windows  should  be  1  meter  from  the  floor.  The  propor- 
tion of  light  to  floor  of  class-rooms  should  never  be  less 
than  1  square  meter  of  glass  surface  to  6  square  meters 
of  floor  surface,  for  rooms  10  meters  wide,  lighted  from 
only  one  side.  Within  the  limits  of  a  city,  where  the 
adjoining  buildings  are  about  6  meters  from  the  exterior 
walls,  this  proportion  should  be  increased  to  1  to  5.  The 
length  of  the  school-room  should  not  be  over  15  meters, 
and  the  width  not  over  10  meters,  while  the  height 
should  be  at  least  3.8  meters. 

lighting. — The  lighting  of  school-buildings  is  a  mat- 
ter of  very  great  importance.  The  windows  should  never 
be  in  the  front  of  the  room,  only  at  the  sides  and  rear. 
It  is  preferable  to  have  them  on  the  left  side  of  the  room, 
so  as  to  have  the  light  falling  over  the  left  shoulder  of 
the  pupil.  The  windows  should  be  provided  with  shades 
or  blinds,  so  that  direct  sunlight  can  be  excluded  as  re- 
quired. 

As  the  sense  of  sight  is  the  chief  medium  of  educa- 
tion, it  is  hardly  possible  to  overestimate  the  importance 
and  necessity  for  carefully  observing  the  management  of 
light  in  school-rooms.  It  has  been  positively  established 
by  careful  and  extensive  statistics  that  myopia  is  most 
frequently,  if  not  exclusively,  developed  during  school- 
life.  This  is  due  partly  to  the  fact  that  the  eye  during 
this  period  of  growth  is  more  liable  to  change  in  form, 
and  partly  to  the  fact  that  children  have  much  stronger 
power  of  accommodation  than  adults,  and  therefore  hold 
objects  more  closely  to  the  eye.  The  book  or  paper 
should  never  be  closer  to  the  eye  than  25  centimeters. 
If  there  is  myopia  sufficient  to  prevent  the  letters  from 
is 


274  SCHOOL  HYGIENE. 

being  distinct  at  this  distance,  it  is  better  to  wear  glasses 
in  the  study-room.  In  erecting  public  schools  it  involves 
a  little  extra  expense  to  provide  windows  of  sufficient 
size.  Architectural  beauty  ought  to  be  a  secondary 
consideration  where  such  grave  practical  interests  are 
involved.  Dr.  Cohen  maintains  that  a  school-room  can- 
not have  too  much  light,  and  recommends  the  very 
large  proportion  of  i  square  meter  of  window  glass  for 
every  square  meter  of  floor  surface,  and  that  less  than 
about  one-half  of  this  proportion  should  never  in  any 
case  be  allowed.  The  arrangement  that  Mr.  Biberich 
advocates  is  to  have  the  class-rooms  of  oblong  shape,  the 
windows  being  on  one  of  the  long  sides  and  the  desks 
arranged  parallel  to  the  short  walls,  so  that  the  light 
falls  from  the  left  side. 

The  Position  of  Blackboards. —  The  blackboards 
should  be  on  the  inner  wall  of  the  room,  where  the 
greatest  amount  of  light  will  fall  upon  them,  and  they 
should  be  of  a  dull-black  color.  The  principal  cause  of 
defective  evesight  in  school-children  is  no  doubt  traceable 
to  improper  lighting  of  the  room,  which  may  be  either 
excessive  light  or  deficient  light,  or  light  coming  from 
the  wrong  direction.  The  position  of  the  blackboards 
and  their  frequent  use  for  copying  exercises,  while  the 
child  is  at  its  desk,  require  rapid  changes  in  the  accom- 
modation, which  is  also  a  factor  in  producing  defective 
eyesight.  Another  factor,  independent  of  the  arrange- 
ment of  the  school-room,  is  the  use  of  books  printed  with 
defective  type  or  with  too  small  a  type. 

Corridors,  Cloak-rooms,  and  Wardrobes. — The  cor- 
ridors should  be  without  obstruction,  and  never  less  than 
2.4  meters,  preferably  3  meters,  wide.  The  stairways 
should  be  1.8  meters  wide,  and  each  flight  should  be 
broken  with  a  landing.  These  stairs  should  be  as  near 
to  the  exit  as  possible,  and  equally  placed  at  each  end  of 
the  building.  The  walls  should  be  of  brick,  and  finished 
in  white  enamelled  brick  or  white  enamelled  paint.  Wall- 
paper should  never  be  allowed  in  school-rooms,  because 


VENTILATION.  275 

of  the  difficulty  of  maintaining  it  in  a  proper  sanitary 
condition. 

As  contagion  is  most  likely  to  occur  from  garments, 
which,  if  porous,  absorb  and  transport  gases,  bacteria, 
etc.,  it  is  necessary  to  have  two  wardrobes  properly  ar- 
ranged on  each  floor,  one  for  each  sex.  The  latest  im- 
proved wardrobes,  set  up  in  separate  rooms  or  in  the 
corridors,  either  in  the  basement  or  on  each  story,  are 
made  with  separate  stalls  of  channel  iron.  At  the  bottom 
is  a  shelf  for  rubbers,  two  rings  and  cups  for  umbrellas, 
with  hangings  on  each  side.  The  best  place  for  ward- 
robes is  in  each  corridor,  provided  it  is  wide  enough. 
Wardrobes  seem  to  be  the  most  difficult  problem  of  school 
sanitation,  there  being  many  advantages  in  the  method 
of  placing  them  in  wide  corridors,  unless  special  rooms 
can  be  provided,  with  thorough  circulation  of  fresh  air. 
The  advantage  of  having  wardrobes  in  the  corridors  is 
that  the  teacher  in  charge  of  that  floor  maintains  the 
discipline,  and  there  will  be  no  travelling  up  and  down 
to  the  basement. 

Ventilation. — With  regard  to  the  introduction  of 
fresh  air,  probably  the  most  satisfactory  arrangement  for 
a  school-building  is  that  by  means  of  indirect  heating, 
where  the  air  required  for  ventilation  is  brought  in  at  the 
desired  temperature,  thus  maintaining  the  temperature 
of  the  room,  while  the  purity  of  the  atmosphere  is  secured 
at  the  same  time. 

As  to  the  best  method  to  introduce  the  requisite  amount 
of  air  into  school-buildings,  numerous  systems  of  ven- 
tilation and  heating  are  in  use,  several  of  which  give 
satisfactory  results,  if  properly  constructed.  If  the 
building  contains  as  many  as  eight  or  ten  rooms,  and  is 
two  or  three  stories  in  height,  it  is  impossible  to  ventilate 
it  satisfactorily  without  the  introduction  of  fans  to  assist 
in  either  propelling  the  incoming  air  or  extracting  the 
foul  air  of  the  rooms.  It  is  customary  to  have  one  of 
these  blowers  in  the  shaft  through  which  fresh  air,  already 
heated  by  passing  over  steam  coils,  makes  its  entrance 


276  SCHOOL  HYGIENE. 

into  the  room  to  be  warmed  and  ventilated.  These  shafts 
are  usually  supplied  with  a  by-pass  valve,  which  is  under 
the  control  of  a  thermostat,  so  that  the  supply  of  air  is 
kept  at  a  definite  temperature  automatically.  As  soon  as 
the  temperature  rises  above  the  desired  point  the  ther- 
mostat cuts  off  the  supply  of  heated  air,  and  allows  cold 
air  to  enter  and  mix  with  the  heated  air.  This  not  only 
facilitates  the  proper  ventilation  of  the  rooms,  but  like- 
wise economizes  the  amount  of  fuel  used.  By  means  of 
fans  it  is  possible  to  introduce  a  definite  amount  of  air  in 
a  definite  period  of  time,  the  entire  circulation  of  air 
being  under  control. 

In  this  method  of  ventilation  and  heating  it  is  possible 
to  place  the  intake  of  fresh  air  at  such  a  point  as  to  pre- 
vent some  of  the  grosser  atmospheric  impurities  from 
gaining  access  to  the  building.  This  point  of  intake 
may  vary  according  to  the  location  of  the  building; 
ordinarily,  it  should  be  at  least  2  or  3  meters  above 
ground.  It  may  be  over  the  roof  of  the  house,  if  it  is 
found  that  at  that  point  the  air  is  purer  than  at  a  lower 
level.  It  is  also  possible  by  this  method  of  ventilation 
and  heating  to  filter  the  air,  in  order  to  remove  the  grosser 
dust  particles,  by  passing  it  through  a  screen  over  which 
a  constant  stream  of  water  is  flowing.  It  is  also  possible 
to  regulate  the  humidity  of  the  air,  to  some  extent,  by 
this  means  of  ventilation  through  this  method  of  filtra- 
tion, the  air  taking  up  some  moisture  in  passing  over  the 
screen. 

Heating". — Heating  may  be  accomplished  either  by 
what  is  known  as  direct  radiation,  as  by  means  of  a  stove 
or  open  fireplace,  or  through  steam  or  hot- water  radiators 
in  the  room.  Or  it  may  be  by  what  is  known  as  indirect 
radiation,  where  the  radiating  surface  is  in  some  other 
portion  of  the  building,  and  the  rooms  are  heated  by 
bringing  in  air  that  is  warmed  by  passing  over  steam  or 
hot-water  coils.  Where  a  system  of  direct  heating  is 
employed,  whether  by  means  of  steam  or  hot  water,  the 
capacity  of  the  heating  plant  should  be  adapted  to  meet 


WA  TER-CLOSE TS  AND  LA  TRINES.  2/7 

the  requirements  placed  upon  it.  Mr.  William  J.  Bald- 
win, in  his  Steam  Heating  Data,  states  that  the  question 
of  condensation  of  steam  receives  the  first  consideration 
in  making  calculations  for  the  heating  of  a  building.  If 
asked  the  question  why  condensation  is  considered  first, 
he  would  reply  that  "  it  furnishes  us  with  the  first  item 
of  data  on  which  to  base  our  calculations.  For  instance, 
when  we  find  the  amount  of  cooling  or  condensation  that 
is  to  take  place  within  a  building  in  the  coldest  weather, 
we  then  know  the  amount  of  water  it  is  necessary  to 
evaporate  to  do  this  work.  Having  the  amount  of  water 
evaporated,  we  can  then  obtain,  in  the  order  we  please,  the 
size  of  boiler  necessary  to  evaporate  the  water,  the  amount 
of  coal  or  other  fuel  that  will  evaporate  that  amount  of 
water,  the  size  of  the  grate  on  which  to  burn  the  coal, 
the  size  and  height  of  chimney  necessary  to  supply  air 
for  combustion,  the  size  of  the  radiators  necessary  to 
condense  the  steam,  the  size  of  pipes  necessary  to  convey 
steam  or  hot  water  to  the  radiators,  and  all  other  attend- 
ant data  which  will  develop  as  we  proceed." 

Water-supply  and  Sewage  Disposal. — The  building 
should  have  an  abundant  supply  of  pure  water,  so  as  to 
insure  against  the  diseases  ordinarily  carried  by  water; 
also  to  facilitate  the  maintaining  of  strict  cleanliness 
among  the  children  in  the  building.  It  is  also  necessary 
to  devise  some  means  for  the  disposal  of  the  sewage,  in 
the  absence  of  a  system  of  sewers.  This  becomes  a 
separate  question  in  different  localities.  In  some  instances, 
where  the  price  of  land  permits,  it  will  probably  be 
safest  and  cheapest  in  the  end  to  have  some  form  of  sur- 
face irrigation.  Where  the  price  of  land  does  not  permit 
this  method  of  disposal,  it  may  be  necessary  to  resort  to 
properly  constructed  cesspools  or  some  of  the  modern 
methods  of  purification. 

Water-closets  and  I,atrines. — Where  there  are  no 
sewers  we  unhesitatingly  use  the  closets;  but  these 
should  discharge  into  specially  constructed  tanks  or  cess- 
pools, so  that  the  sewage  may  be  disposed  of  in  a  sanitary 


278  SCHOOL  HYGIENE. 

manner.  There  should  be  no  connection  of  any  kind 
between  the  class-rooms  and  the  water-closets.  In  no  case 
should  wastes  of  sinks  be  discharged  into  the  vaults.  The 
wastes  should  enter  a  cesspool,  preferably  a  double  cesspool 
— with  a  tight  compartment  for  solids  and  a  leeching  one 
for  liquids.  The  best  urinal  is  of  slate,  with  the  dry-earth 
system.  There  should  be  a  connecting  waste  from  the 
trough  and  a  connection  with  the  cesspool  drain.  Water- 
closets  for  the  pupils'  use,  where  there  is  water  carriage, 
should  be  with  automatic  seats.  Thick  porcelain  slabs, 
with  backs,  are  the  best  and  cheapest  devices  for  drinking- 
fountains  in  the  corridors.  The  plumbing  of  the  building 
should  be  the  best  obtainable,  with  tight  joints  and  as  few 
bends  in  the  pipes  as  possible;  and  these  pipes  should  be 
properly  ventilated  by  means  of  an  open  trap  outside  the 
building,  between  it  and  the  sewer,  and  by  carrying  the 
other  end  of  the  soil  pipe  up  over  the  roof  of  the  build- 
ing, of  the  same  diameter  throughout.  All  the  traps  of 
the  water-closets  and  sinks  must  be  back-aired,  in  order 
to  insure  against  the  production  of  foul  odors  in  the 
un ventilated  ends  of  the  pipe;  and  also  to  prevent  the 
unsealing  of  these  traps. 

Each  story  of  the  school-building  should  be  provided 
with  suitable  water-closets,  with  automatic  flushing  ar- 
rangements. These  toilet-rooms  should  also  be  provided 
with  sinks,  so  as  to  facilitate  maintaining  a  proper  degree 
of  cleanliness  of  the  hands  and  persons  of  the  pupils. 
The  expense  of  soap  and  towels  to  the  community  is  a 
small  one  compared  with  the  detriment  occasioned  by 
permitting  the  children  to  come  in  contact  with  each 
other  when  some  of  them  are  not  as  cleanly  as  they 
should  be. 

Desks  and  Seats. — The  height  of  the  seat  must  cor- 
respond with  the  length  of  the  pupil's  legs  below  the 
knees.  The  seat  may  be  horizontal  or  slightly  curved. 
The  back  of  the  seat  should  be  composed  of  an  upper  con- 
cave portion  and  of  a  lower  convex  portion,  so  as  to  con- 
form to  the  back  of  the  pupil,  and  it  should  be  of  suffi- 


DESKS  AND  SEA  TS. 


279 


Fig.  51. — Comparative  diagram  showing  (a)  the  proper  position  at  a 
desk;  (6)  the  position  when  the  desk  is  too  low;  and  (c)  the  position  when 
the  desk  is  too  high  (after  Cohn). 


w 


Fig.  52. — Position  assumed  in  writing  with  the  desk  too  high. 


28o 


SCHOOL  HYGIENE. 


cient  height  to  support  properly  the  pupil's  back  (Fig. 
51).  The  writing  desk  should  have  an  inclination  of 
about  15  degrees.  The  desk  should  be  fitted  to  the  size 
of  each  pupil.  The  prevalence  of  lateral  curvature  of 
the  spine  in  children  is  traceable  to  the  use  of  desks 
that  are  entirely  too  high  or  too  low  (Figs.  52  and  53). 
Defects  in  School-buildings. — During  1896-97  a 
committee  of  the  Women's  Health  Protective  Association 
of  Philadelphia,  with  the  assistance  of  Professor  Wood- 
bridge,   of  the  Boston  Institute  of  Technology,  made  a 


Fig.  53. — Position  assumed  in  writing  with  the  desk  too  low. 

very  thorough  examination  into  the  hygienic  condition 
of  160  public-school  buildings  of  Philadelphia.  In  sum- 
ming up  the  result  of  their  investigation  they  say  that, 
next  to  uncleanliness,  the  greatest  evil  related  to  improper 
ventilation;  of  small  yards,  due  to  the  close  proximity 
of  buildings,  some  of  them  many  stories  in  height;  the 
presence  of  coal  gas;  lack  of  sunshine;  in  the  outside 
air,  close  proximity  of  outhouses  improperly  constructed 
or  carelessly  cleaned  and  flushed;  the  keeping  of  wraps 
in  school-rooms  or  adjacent  unventilated  closets,  and 
the  almost   total   absence   of    ventilation   by   transoms, 


MEDICAL  INSPECTION  OF  SCHOOLS.  281 

and  in  many  instances  the  use  of  storm  doors,  rendering 
ventilation  impossible  save  at  the  expense  of  the  chil- 
dren's health.  In  one  building,  accommodating  200 
children,  the  sun  never  entered,  save  in  one  room  at  the 
noon  intermission.  In  some  buildings  there  were  as  many 
as  nine  rooms  never  cheered  by  the  sun.  Fan  or  shaft 
ventilation  could  not  be  introduced  without  great  ex- 
pense, but  properly  arranged  door  and  window  transoms 
for  ventilation  could  be  placed  in  every  building  at  little 
cost,  thus  admitting  fresh  air  without  occasioning  draft. 
This  committee  recommended  that  every  building  should 
be  supplied  with  such  means  of  ventilation  as  will  insure 
free  circulation  of  air  throughout  the  building.  The 
prolific  cause  of  the  spread  of  contagious  diseases  is  the 
keeping  of  wraps  in  school-rooms.  The  committee 
found  that  at  least  three-quarters  of  the  older  buildings 
had  no  cloak-rooms,  or  very  inadequate  ones.  In  many 
cases  there  were  no  means  of  ventilating  such  rooms 
except  through  the  school-rooms.  Seventeen  cases  of 
scarlet  fever  occurred  in  one  airy,  spacious  building  in 
1895,  and  3  additional  cases  in  1896.  This  epidemic  was 
doubtless  due  to  the  lack  of  cloak-rooms. 

On  January  24,  1898,  Dr.  J.  Howard  Taylor,  medical 
inspector  of  the  health  bureau,  made  his  annual  report 
on  the  sanitary  condition  of  the  public-school  buildings 
of  the  city  of  Philadelphia.  Dr.  Taylor  mentions  all 
the  school-buildings,  telling  their  good  points  as  well  as 
their  bad  ones,  and  notes  the  many  improvements  which 
have  been  made  because  of  the  complaints  of  former 
years.  The  most  important  defects  noted  in  the  different 
buildings  are:  Imperfect  ventilation,  insufficient  water- 
supply  for  the  latrines,  imperfect  lighting,  absence  of 
cloak-rooms,  and  unsatisfactory  heating  of  the  buildings, 
giving  rise  to  gas  in  the  school-room  from  defective  fur- 
naces. These  defects  were  noted  in  a  very  large  number 
of  the  school-buildings. 

Medical  Inspection  of  Schools.— In  some  of  the 
countries  of  Europe  medical  inspection   of  schools  has 


282  SCHOOL  HYGIENE. 

been  developed  to  a  far  higher  plane  than  in  America. 
In  Hungary,  for  instance,  the  position  of  school  physi- 
cian is  an  established  one,  and  the  duties  of  this  officer 
are  well  denned.  It  is  the  duty  of  the  school  physician 
to  examine  and  study  the  school-buildings  from  a  sani- 
tary standpoint,  as  well  as  their  contents  and  surround- 
ings. It  is  his  duty  to  investigate  the  purity  of  the  air 
in  each  class-room,  and  analyze  it  systematically  from 
time  to  time.  He  must  inspect  the  lighting,  heating, 
and  ventilation  of  each  of  the  class-rooms,  and  regulate 
the  number  of  children  in  each  room.  On  the  basis  of 
yearly  measurement  and  examination  of  the  children,  he 
must  direct  the  proper  seating  of  each,  not  only  with  re- 
gard to  the  adaptability  of  the  form  and  size  of  the  desks 
to  the  age  of  the  pupils,  but  also  with  regard  to  special 
requirements  of  certain  pupils  on  account  of  defective 
eyesight  or  hearing.  He  is  also  required  to  analyze  the 
drinking-water  used  in  the  schools,  and  endeavor  to  pro- 
cure healthy  drinking-water.  When  disinfection  of  the 
school  becomes  necessary,  he  must  see  that  it  is  properly 
carried  out. 

When  the  school  physician,  in  any  of  these  instances, 
notices  hygienic  defects,  he  must  inform  the  director  of 
the  institution,  and  make  suggestions  for  remedying  or 
removing  such  defects.  He  must  also  see  that  the  laws 
of  public  health  and  the  legislation  of  the  board  are 
carefully  carried  out. 

With  regard  to  the  health  of  the  pupils,  it  is  the  duty 
of  the  school  physician  to  examine  all  new  pupils  on 
entering  a  school.  These  examinations  are  to  be  of  such 
a  detailed  and  systematic  character  as  to  afford  a  knowl- 
edge of  the  health  of  each  child.  He  must  make  special 
observations  to  determine  the  extent  to  which  the  pupil 
may  safely  take  part  in  the  regular  gymnastic  exercises 
of  the  school,  or  whether  these  must  be  in  part  or 
entirely  prohibited.  He  must  examine  each  new  pupil 
to  determine  whether  it  is  suffering  from  any  infectious 
disease,  especially  tuberculosis.      He  must  also  examine 


MEDICAL  INSPECTION  OF  SCHOOLS.  283 

the  spinal  column  to  determine  the  presence  of  curvature, 
in  order  that  special  gymnastic  exercises  may  be  pre- 
scribed to  overcome  this  defect.  He  must  examine  the 
eyes  and  ears,  and  determine  the  degree  of  vision  and  the 
hearing  power. 

These  systematic  examinations  of  the  pupils  are  re- 
peated during  the  school  year,  and  a  careful  record  must 
be  kept  of  the  progress  of  each  pupil  in  regard  to  the 
uniform  and  healthful  development  of  the  body. 

The  sanitary  inspection  of  schools  and  school-children 
has  been  very  generally  adopted  in  the  larger  cities  of 
the  United  States  during  the  last  decade.  Where  such  a 
system  is  adopted,  as  in  New  York,  Boston,  Chicago,  and 
Philadelphia,  a  corps  of  medical  inspectors  is  appointed, 
whose  duty  it  is  to  examine  all  children  whom  the 
teacher  believes  to  be  suffering  from  disease.  In  this 
manner  many  incipient  cases  of  infectious  disease  are 
detected  and  isolated  before  the  danger  of  dissemination 
is  very  great.  The  great  value  of  these  inspections  is 
shown  in  a  report  made  by  Dr.  A.  R.  Reynolds,  Health 
Commissioner  of  Chicago,  October  30,  1900,  to  the  Board 
of  Education.  "  Since  the  beginning  of  the  year  75,000 
children  have  been  detained  by  school  principals  for 
medical  inspection,  and  of  these,  4539  were  temporarily 
excluded  from  school  on  account  of  danger  of  contagion. 
As  a  result  of  this  precaution  there  has  been  a  very  notable 
decrease  in  the  mortality  from  infectious  diseases,  espe- 
cially diphtheria  and  scarlet  fever. ' '  The  report  of  the 
medical  inspectors  of  Philadelphia,  made  October  30, 
1900,  and  covering  the  first  eight  months  of  their  work, 
shows  that  5876  cases  of  disease  were  found  in  the  public 
schools,  of  which  3446  were  contagious.  Among  the 
latter  were  12  cases  of  diphtheria,  4  of  scarlet  fever,  112 
of  measles,  118  of  mumps,  and  212  of  pediculosis  ;  con- 
tagious skin-diseases,  116  ;  ringworm,  753  ;  conjuncti- 
vitis, 397  ;  scabies,  8  ;  whooping-cough,  20  ;  typhoid 
fever,  3  ;  tuberculosis,  2  ;  and  scalp  diseases,  8.  More 
than  1000  cases  of  defective  vision  were  found. 


284  SCHOOL  HYGIENE. 

The  medical  department  of  the  Philadelphia  High 
School  for  girls  was  established  in  1893.  Prior  to  this 
time  the  attendance  of  any  physician  was  depended  upon 
in  an  emergency,  so  that  much  time  was  lost,  and  the 
uncertainty  of  obtaining  assistance  was  great.  In  1893 
the  services  of  a  graduate  of  the  Woman's  Medical 
College  were  secured.  The  duties  of  the  head  of  the 
medical  department  constantly  increased  from  one  hour 
a  day  to  continual  attendance  from  the  opening  of  the 
school  at  9  A.  m.  until  the  close  of  the  session  at  2  P.  M. 

At  the  beginning  of  each  school  year  in  September  all 
vaccination  certificates  and  scars  are  examined ;  in  doubt- 
ful cases  a  certified  re-vaccination  is  required.  Teachers 
at  the  beginning  of  each  morning  session  inquire  whether 
any  student  is  suffering  from  sore  throat,  headache  or 
other  ailment;  all  such  are  at  once  referred  to  the  medical 
room.  A  daily  record  of  students  sent  to  the  medical 
room  is  carefully  kept.  Any  student  with  a  temperature 
of  ioo°  F.  is  detained  in  the  "  sick-room  "  until  the  tem- 
perature becomes  normal.  If  a  rise  takes  place,  the 
student  is  sent  home  in  a  carriage.  On  stormy  days 
students  who  have  wet  shoes,  stockings,  or  skirts  are 
required  to  report  at  the  medical  room,  where  dry  gar- 
ments are  provided.  All  wet  clothing  is  dried  in  a  room 
prepared  for  the  purpose,  and  is  made  ready  for  the 
student  at  recess  in  the  medical  room  at  noon.  Every 
part  of  the  entire  building  is  thoroughly  cleansed  daily. 
The  balustrades  and  desks  throughout  are  carefully 
cleansed  each  day  with  antiseptic  solution.  The  drink- 
ing-water is  filtered,  then  sterilized,  and  the  ice  is  made 
from  sterile  water.  The  sanitary  condition  of  the  toilet- 
rooms  is  excellent.  There  are  now  individual  compart- 
ments,  where  formerly  there  were  congregate  rooms. 

The  medical  department  is  ideal  in  location,  having  a 
south  and  east  exposure,  with  a  good  supply  of  sunlight, 
while  its  situation  insures  all  the  quiet  necessary.  This 
room  is  supplied  with  all  that  is  required  for  any  emer- 
gency that  is  likely  to  occur.      There  is  an  ample  supply 


MEDICAL  INSPECTION  OF  SCHOOLS.  285 

of  filtered  water  and  appliances  for  obtaining  boiling 
water.  The  department  is  provided  with  four  wicker 
couches  with  cushions  covered  with  linen  slips;  the  latter 
are  frequently  removed  and  laundered,  while  the  cushions 
themselves  are  detached,  shaken,  and  placed  in  the  sun- 
light. A  part  of  the  engine-room  space  is  used  for 
drying  clothing. 

That  the  work  of  the  department  has  been  greatly 
appreciated  is  evident  by  the  letters  and  personal  visits 
from  parents  and  physicians  of  the  students.  The  num- 
ber of  students  on  roll  during  one  school  year  was  3402, 
with  a  faculty  of  87  teachers.  During  the  year  2233 
students  were  referred  to  the  medical  room:  702  with 
headache,  137  with  sore  throat,  127  with  toothache,  531 
with  dysmenorrhea,  21  with  epistaxis,  45  with  diarrhea, 
26  with  earache,  139  with  indigestion,  150  with  nausea, 
99  with  hysteria,  21  with  grip.  Accidents :  Dislocations 
(minor),  3;  sprains,  18;  burns  (slight),  11;  scalds  (slight), 
3;  splinters,  54;  contused  wounds  (slight),  28;  lacerated 
wounds  (slight),  34;  incised  wounds  (slight),  4;  punctured 
wounds  (slight),  4;  poisoned  wounds  (slight),  3;  foreign 
bodies  in  the  eye,  49;  foreign  bodies  in  the  ear,  1.  Con- 
tagious Diseases  :  Measles,  6;  scarlet  fever,  2;  ringworm, 
1;  Pediculosis  capitis,  9.  Seventy-four  were  sent  to 
their  homes. 


CHAPTER     XIII. 
MILITARY    HYGIENE. 

The  health  and  efficiency  of  an  army  are  dependent 
upon  the  physical  condition  of  the  individual  soldier  and 
the  hygienic  condition  of  his  environment,  the  nature  of 
his  food-supply,  qualitatively  as  well  as  quantitatively; 
the  nature  of  his  clothing,  and  the  nature  and  extent  of 
his  physical  exercise. 

The  Recruit. — It  is  evident  that  the  health  and  effi- 
ciency of  an  army  rest  fundamentally  upon  the  physical 
condition  of  the  recruit,  and  consequently  great  care  is 
exercised  in  the  selection  of  individuals  for  enlistment. 
The  physical  condition  and  endurance  of  the  recruit  are 
influenced  directly  by  his  age,  height,  weight,  and  gen- 
eral physical  development. 

The  age  of  the  recruit  has  an  important  influence  upon 
his  physical  endurance  and  adaptability  to  the  service. 
In  men  of  eighteen  to  twenty  years  of  age  the  ossifica- 
tion of  the  bones  and  the  general  muscular  develop- 
ment are  as  yet  incomplete,  and  therefore  they  are  more 
liable  to  succumb  to  the  strenuous  duties  of  the  soldier. 
In  like  manner,  men  over  forty-five  years  of  age  fre- 
quently lack  endurance  because  of  beginning  degenera- 
tive changes  in  the  circulatory  organs.  It  has  been  found 
that  the  most  inefficient  armies  were  those  in  which  the 
largest  proportion  of  the  men  were  below  twenty-two 
years  of  age,  though  it  has  also  been  found  that  young 
men  are  most  easily  trained  and  are  more  likely  to  follow 
orders  without  question.  The  age-limit,  except  in  cases 
of  re-enlistment,  should,  therefore,  be  from  twenty-one 
to  thirty-five  years. 

In  peace  the  maximum  age  for  cavalry  is  thirty  years, 

286 


THE  RECRUIT. 


287 


for  all  other  arms,  thirty-five  years;  the  minimum  for 
musicians,  sixteen  years,  for  all  others,  eighteen  years. 
Volunteers  are  accepted  between  eighteen  and  forty-five, 
but  men  were  drafted  in  the  Civil  War  only  between 
twenty  and  forty-five  years.  The  unorganized  militia 
are  between  eighteen  and  forty-five  years.  In  the  Eng- 
lish army,  according  to  Parke,  men  are  enlisted  from 
eighteen  to  twenty-five  years  of  age. 

The  relative  proportions  of  height,  weight,  and  chest 
measurement  of  the  recruit  are  valuable  indicators  of  his 
general  physical  development,  and,  therefore,  of  his 
adaptability  for  the  service. 

The  following  table1  shows  the  relative  proportions 
of  height,  weight,  and  chest  measurement  as  found  in 
average  men: 


Chest  Measurement. 

Height. 

Weight. 

At  Expiration. 

Mobil 

ty- 

Feet. 

Inches. 

Cm. 

Pounds. 

Kg. 

Inches.      Cm. 

Inches. 

Cm. 

5l\ 

64 

162.5 

128 

57-9 

32           8l.2 

2 

5-0 

5fV 

65 

165-1 

130 

53.8 

32           83.S 

2 

5-o 

5A 

66 

167.6 

132 

59-7 

32*         85.O 

2 

5-0 

5A 

67 

I  70. 1 

134 

60.7 

33         86.3 

2 

5.0 

J  1  2 

68 

172.7 

141 

63.8 

33i      86.9 

A 

6-3 

c  9 

JT2 

69 

175-2 

148 

67.0 

33i      87.6 

2! 

6-3 

J12 

7o 

177.8 

155 

70.2 

34        88.9 

2! 

6-3 

J12 

7i 

180.3 

162 

73-3 

34i       89.5 

2\ 

6-3 

6 

72 

182.8 

169 

76.5 

34i       9°-8           3 

8.8 

*A 

73 

185.4 

176 

79-7 

35j      92.0           3 

8.8 

It  is,  however,  the  manual  states,  not  necessary  for  the 
recruit  to  conform  exactly  to  the  figures  in  the  table.  A 
variation  of  10  pounds  (4.5  kg.)  in  weight  or  2  inches 
(5  cm.)  in  chest  measurement  (at  expiration)  below  the 
standard  given  in  the  table  is  admissible,  provided  the 
applicant  is  otherwise  vigorous  and  healthy. 

The  Surgeon-General  gives  the  following  directions 
for  the  examination  of  recruits: 

"The  minimum  height  of  a  recruit  is  at  present  fixed 
at  5  feet  4  inches  for  all  branches  of  the  service,  although 

1  Manual  of  the  Medical  Department  of  the  Army,  edition  of  1900,  p.  101. 


288  MILl TAR  Y  HYGIENE. 

recruiting  officers  are  allowed  to  exercise  their  discretion 
as  to  the  enlistment  of  desirable  recruits  (such  as  band 
musicians,  school-teachers,  tailors,  etc.)  who  may  fall  not 
more  than  \  inch  below  the  minimum  standard  of  height; 
the  maximum  height  for  the  calvary  service  is  5  feet  10 
inches;  that  for  infantry  and  artillery  is  governed  by  the 
maximum  weight,  to  which  should  be  applied  the  rule 
for  proportion  in  height. 

"The  minimum  weight  for  all  recruits  is  125  pounds, 
except  for  the  cavalry,  in  which  enlistment  may  be  made 
without  regard  to  a  minimum  weight  provided  the  chest 
measurement  and  chest  mobility  are  satisfactory.  The 
maximum  for  infantry  and  artillery  is  190  pounds;  for 
cavalry  and  light  artillery,  165  pounds. 

' '  The  chest  mobility — i.  e. ,  the  difference  between  the 
measurement  at  inspiration  and  expiration — should  be  at 
least  2  inches  in  men  below  5  feet  7  inches  in  height,  and 
2\  in  those  above  that  height." 

The  height  of  recruits  must  be  at  least  165  centimeters; 
minimum  chest  measurement,  75  centimeters,  with  at 
least  5  centimeters  expansion;  and  the  weight  54  to  81 
kilograms.  In  the  cavalry  service  the  maximum  weight 
is  75  kilograms. 

According  to  Parke,  probably  63  inches  at  nineteen 
years  of  age,  and  120  pounds  weight,  should  be  the 
minimum  height  and  weight  according  to  age,  even  in 
times  of  greatest  pressure. 

In  France  the  weight  is  reckoned  at  the  rate  of  700  to 
725  grams  for  each  centimeter  of  chest  circumference. 

Any  defect  or  deformity  which  is  likely  to  interfere 
with  the  duties  of  a  soldier  will  cause  the  rejection  of  the 
applicant.  He  must  have  free  use  of  his  limbs  and  be 
active  and  vigorous.  The  character  of  the  feet  and  legs 
is  a  most  important  matter  for  investigation  by  the  re- 
cruiting officer  because  of  the  nature  of  the  service  in 
which  the  soldier  engages.  Any  defects  or  imperfect 
development  of  the  feet  and  legs  will  probably  be  detected 
by  the   examining  officer  from  the  exercise  in  walking, 


TRAINING  OF  THE  RECRUIT.  289 

running,  and  jumping  to  which  the  applicant  is  subjected. 
The  hearing  must  be  normal  and  the  vision  without 
evident  defect.  The  recruit  must  be  ' '  effective,  able- 
bodied,  sober,  free  from  disease,  and  of  good  character 
and  habits."  The  mere  fact  that  the  recruit  presents 
himself  for  examination  in  ragged  or  filthy  clothes,  or  is 
filthy  in  his  person,  is  sufficient  to  cause  his  rejection. 
The  most  frequent  cause  of  rejection  of  applicants  is 
some  form  of  defective  development.  For  the  year  1899 
there  were  examined  70,311  men  for  enlistment  in  the 
regular  army,  of  whom  47,899  were  accepted,  or  681.24 
out  of  every  1000  examined.  "  Of  every  1000  examined, 
74.56  were  rejected  on  account  of  imperfect  physique, 
including  overheight,  underheight,  overweight,  and  un- 
derweight; 41.43  for  diseases  of  the  eye,  38.06  for  diseases 
of  the  circulatory  system,  26.53  for  diseases  of  the  diges- 
tive system,  22.43  f°r  affections  of  the  genito-urinary 
system,  17  for  venereal  diseases,  9.61  for  hernia;  while 
9.81  were  rejected  as  generally  unfit  or  undesirable,  3.74 
as  minors,  3.12  on  account  of  bad  or  doubtful  character, 
and  only  1.32  on  account  of  illiteracy,  imperfect  knowl- 
edge of  the  English  language,  or  mental  insufficiency."  l 

Training-  of  the  Recruit. — Physical  Training. — In 
order  to  increase  his  endurance,  as  well  as  add  to  his 
general  usefulness  as  a  soldier,  the  recruit  must  be  sub- 
jected to  thorough  physical  training  as  well  as  training 
in  the  art  of  war  before  engaging  in  active  warfare. 
Physical  training,  if  conducted  systematically,  will  greatly 
increase  the  endurance  of  the  raw  recruit.  Without  this 
preliminary  training  most  men,  however  well  propor- 
tioned they  may  be,  will  succumb  to  the  arduous  duties 
of  active  warfare. 

The  recruit  should  be  instructed  in  swimming,  not 
only  because  it  is  a  most  useful  physical  training,  but 
also  because  it  is  an  acquirement  that  may  be  of  the 
greatest  service  in  his  calling.  Dancing,  fencing,  and 
general  gymnastic  exercises  are  of  great  value  in  training 

1  Report  of  the  Surgeon-  General,  p.  27,  1900. 
19 


290  MILITARY  HYGIENE. 

the  coordinate  movement  of  muscles,  as  well  as  in  aiding 
in  the  uniform  development  of  the  body  and  in  increasing 
the  general  physical  endurance.  Exercises  in  singing 
are  valuable  in  improving  the  lungs  and  in  developing 
the  breathing  capacity.  Any  exercise  that  aids  in  im- 
proving the  general  physical  condition  of  the  body  should 
be  made  use  of  in  the  preliminary  training  of  the  recruit. 

Moral  Training. — The  great  danger  from  vice  in  the 
army  arises  principally  from  the  fact  that  large  num- 
bers of  men  are  brought  together,  and  are,  in  times  of 
peace,  compelled  to  spend  a  portion  of  their  time  in  com- 
parative idleness.  The  utilization  of  definite  portions 
of  each  day  in  perfecting  the  men  in  their  knowledge 
of  the  military  art  will,  in  large  part,  prevent  vice,  and 
gives  at  the  same  time  healthful  occupation  to  the  mind, 
thus  preventing  home-sickness.  The  soldier  should  also 
be  instructed  in  other  lines  of  useful  knowledge,  such  as 
cooking,  washing,  and  sewing,  so  that  he  may  contribute 
toward  the  general  comfort  of  the  army  as  well  as  his 
own  welfare. 

The  influence  of  the  canteen  law  has  given  rise  to  a 
great  deal  of  discussion  recently.  There  are  two  sides  to 
this  question,  each  having  its  earnest  advocates,  and  it  is 
evident  that  the  solution  of  the  problem  should  be  left  to 
the  efficient  heads  of  the  army.  They  have  opportunities 
for  the  formation  of  unbiased  judgment  which  are  denied 
to  those  on  the  outside.  A  priori,  the  entire  exclusion 
■of  alcoholic  beverages  would  be  preferable,  by  far,  if  it 
could  be  accomplished. 

The  Association  of  Military  Surgeons,  in  its  annual 
convention  at  St.  Paul,  May,  1901,  unanimously  adopted 
a  resolution  declaring  that  the  abolition  of  the  canteen 
had  resulted  in  an  increase  of  "intemperance,  insubor- 
dination, discontent,  desertion,  and  disease,"  at  the  vari- 
ous army  posts,  and  urging  that  it  should  be  re-established 
at  the  earliest  possible  date,  "  in  the  interests  of  discipline, 
morality,  and  sanitation." 

Food  of  the  Soldier. — Under  present  laws  and  regu- 


TRAINING  OF  THE  RECRUIT.  291 

lations  the  soldier  may  have  any  variation  of  his  diet 
within  certain  money  value  limits  which  his  officers  con- 
sider necessary  for  his  well-being.  His  ration  is  fixed  by 
law,  but  his  diet  depends  on  the  intelligent  supervision 
of  company  officers  and  the  ability  of  company  cooks. 
Major  Howard1  states  that  "the  diet  of  the  soldier  is 
what  the  company  commander  and  his  first  sergeant  and 
cook  may  choose  to  make  it,  the  materials  being  amply 
provided  by  the  official  ration." 

The  soldier's  ration  consists  of  the  following  :  342 
grams  of  pork  or  bacon,  or  567  of  fresh  beef ;  454  of  hard 
bread,  or  566  of  flour  ;  68  of  beans  or  peas,  or  45  of  rice 
or  hominy  ;  45  of  green  coffee  ;  17  of  salt  ;  68  of  sugar; 
besides  pepper,  vinegar,  and,  at  times,  tea  instead  of 
coffee. 

The  food  should  be  thoroughly  cooked,  and  free  from 
fermentative  or  putrefactive  changes.  Ripe  fruit  may 
be  eaten  in  moderation,  but  green  or  over-ripe  fruit 
should  be  avoided,  because  these  give  rise  to  disturbances 
of  the  digestive  organs. 

With  such  ample  provision  of  materials  it  has  generally 
been  found  possible  to  adapt  the  diet  to  any  climatic  con- 
ditions to  which  our  army  has  been  subjected  in  the  past 
few  years.  No  doubt  some  difficulty  was  experienced  in 
supplying  the  full  complement  of  fresh  meat  and  vege- 
tables in  the  tropics  at  all  times,  on  account  of  the  great 
distance  from  the  base  of  supplies,  but,  in  general,  there 
appears  to  have  been  little  real  inconvenience. 

There  has  been  considerable  discussion  as  to  the  suit- 
ability of  the  ration  to  tropical  conditions,  some  claiming 
that  an  excess  of  fat  and  a  deficiency  of  carbohydrates 
in  the  form  of  fresh  vegetables  and  fruit  was  supplied. 
There  is,  however,  provision  in  the  law  allowing  com- 
mutation of  the  rations,  thus  permitting  the  purchase  of 
food  in  the  local  markets,  and  in  this  manner  any  defects 
in  the  materials  supplied  can  be  remedied  to  advantage. 

Unless   the   duties  of  the  soldier  in    the   tropics   are 

1  Sttrgeon-  General 's  Report,  p.  174,  1900. 


292  MILITARY  HYGIENE. 

arduous,  thus  necessitating  a  diet  rich  in  proteids,  the 
use  of  a  greater  proportion  of  vegetables  and  ripe  fruit 
than  is  the  custom  in  colder  climates  would  serve  to  re- 
duce the  danger  from  disordered  gastro-intestinal  function 
in  large  part.  Along  with  the  use  of  pure  water  such  a 
diet  should  serve  to  lessen  the  suffering  from  diarrhea 
and  dysentery. 

Clothing  of  the  Soldier. — The  clothing  of  the  soldier 
requires  intelligent  supervision  in  order  to  adapt  it  to  the 
climate  of  the  locality  in  which  he  is  serving  as  well  as 
to  seasonal  variations. 

Underclothing. — Light  woollen  underclothing  should 
be  supplied,  even  in  the  tropics,  because  it  takes  up 
moisture  from  the  skin  very  readily,  and  thus  protects 
against  chill  after  exercise.  The  stockings,  on  the  other 
hand,  should  be  composed  of  about  equal  parts  of  cotton 
and  wool.  Woollen  stockings  are  apt  to  cause  sweating 
of  the  feet,  and  thus  induce  a  tender  condition  of  the  feet 
which  is  likely  to  produce  discomfort  or  even  suffering. 
Cotton  stockings  are  apt  to  be  cold,  and  are  therefore  not 
suited  for  colder  climates.  Gray  flannel  shirts  should  be 
supplied  except  for  service  in  the  tropics,  where  a  cotton 
shirt  may  be  substituted  when  light  woollen  under- 
clothing is  worn. 

Outer  Garments. — The  uniform  should  be  adapted  to 
the  occupation  and  to  the  climate.  In  colder  climates 
woollen  garments  should  be  supplied,  the  weight  of  the 
goods  being  regulated  according  to  the  locality.  In  the 
tropics,  and  during  summer  in  the  temperate  zone,  the 
garments  should  be  made  of  materials  which  allow  of  the 
free  circulation  of  air.  The  khaki  cloth  now  generally 
in  use  for  the  uniform  supplied  to  troops  in  the  tropics 
has  proved  quite  satisfactory. 

The  color  of  the  uniform  is  of  great  importance,  not 
only  on  account  of  its  heat-absorbing  powers  and  the 
facility  with  which  it  allows  the  heat  of  the  body  to  pass 
off,  but  likewise  because  of  the  extent  to  which  it  ren- 
ders the  soldier  visible  at  a  distance.     Red  is  the  most 


CLOTHING  OF  THE  SOLDIER.  293 

conspicuous  color,  white  is  next  in  order,  while  gray  is 
least  conspicuous.  The  khaki  uniforms  are  very  well 
adapted  from  this  standpoint.  This  is  a  point  that  should 
be  considered  by  the  State  in  order  to  conserve  the  life 
and  safety  of  its  soldiers.  During  the  conflict  in  South 
Africa  the  British  officers  are  reported  to  have  suffered 
disproportionately  on  account  of  the  color  of  their  uni- 
form. 

The  head-covering  is  of  great  importance,  especially 
in  the  tropics,  where  the  head  and  face  should  be  shaded 
from  the  fierce  rays  of  the  sun  and  against  rain.  The 
hat  worn  by  the  troops  in  the  tropics  meets  these  points 
fairly  well.  It  is  light,  and  allows  free  circulation  of  air, 
thus  limiting  the  danger  from  sunstroke. 

The  shoes  should  be  adapted,  as  near  as  may  be,  to  the 
feet  of  the  individual  wearing  them.  In  order  to  be  able 
to  meet  this  demand  satisfactorily,  the  State  should  sup- 
ply the  common  sizes  and  shapes  of  sole,  and,  besides 
this,  make  to  order  the  shoes  of  those  that  cannot  be 
fitted  properly  from  stock.  A  great  deal  of  discomfort 
and  suffering  may  be  avoided  by  such  a  course,  besides 
enhancing  the  endurance  and  efficiency  of  the  soldier. 

While  on  the  march  each  soldier  carries  also  his  blanket 
and  waterproof,  and  in  cold  climates  his  overcoat.  These 
articles  of  clothing  are  made  up  into  a  roll,  together  with 
the  toilet  articles,  and  this  is  slung  over  the  shoulder.  It 
is  not  likely  that  the  knapsack  formerly  in  use  will  again 
find  favor.  It  gave  rise  to  discomfort,  and  at  times  proved 
positively  injurious  because  it  had  to  be  buckled  on  firmly 
and  therefore  impeded  the  free  movements  of  the  soldier's 
arms  and  chest. 

When  the  soldier's  clothing  or  bedding  becomes  damp 
from  exposure  to  rain  or  heavy  dews,  it  should  be  dried 
in  the  sun  or  by  fires  at  the  first  opportunity  that  pre- 
sents itself. 

The  following  is  Major  Meacham's  opinion  with  regard 
to  the  soldier's  clothing  for  field-service  in  the  tropics, 
based  upon  his  experience  in  northern  Luzon,  P.  I.  : 


294  MILITARY  HYGIENE. 

"  The  clothes  must  be  loose  and  comfortable.  On  the 
march,  part  woollen  should  be  worn  next  the  body.  Ex- 
perience during  the  past  wet  and  dry  seasons  shows  that 
the  clothing  now  furnished  is  fairly  well  adapted  to  this 
climate.  The  supply  at  the  depots  has  been  sufficient. 
The  shoes  and  socks  give  entire  satisfaction.  For  the 
march  the  light  woollen  sock  is  preferable. 

"The  recent  issue  of  campaign  hat,  with  corrugated 
sweat-bands  and  ventilation  in  the  sides,  possesses  ad- 
vantages not  obtainable  in  other  forms  of  headgear  for 
constant  use  and  all-around  field-service.  It  is  far  superior 
to  the  straw  hat,  and,  during  the  rainy  season,  to  any 
cork  or  pith  helmet.  The  latter  requires  more  or  less 
care  at  all  times,  both  on  and  off  the  head. 

"A  part  woollen  undershirt  is  necessary  to  protect  the 
body  from  sudden  chilling.  The  cotton  or  nankeen  under- 
shirt is  cold,  clammy,  and  sticks  to  the  body  while  in 
profuse  perspiration.  This  is  especially  noticeable  during 
the  five  minutes'  rest  given  hourly  on  a  regular  march. 

"The  lighter  issue  of  the  blue  flannel  shirt  answers 
fairly  well  at  all  times,  but  is  objectionable  in  some  re- 
spects. Its  color  more  rapidly  absorbs  the  heat,  and  can 
be  distinguished  a  long  distance,  making  the  wearer  a 
good  mark  for  the  enemy.  A  gray  flannel  shirt  of  medium 
weight  is  preferable.  The  flannel  shirt  has  the  advantage 
of  keeping  the  body  warm,  even  when  wet,  night  and  day. 
The  soldier  prefers  to  wear  the  blue  flannel  shirt  on  the 
march,  with  no  undershirt,  the  sleeves  rolled  up,  open  in 
front,  and  the  collar  well  rolled  back.  It  is  thus  made 
very  comfortable,  the  campaigner  readily  becoming  ac- 
customed to  the  sun's  rays.  One  great  objection  to  this 
shirt  is  its  irritating  effect  on  the  skin.  On  returning  to 
camp  at  night  the  soldier  puts  on  the  cotton  undershirt 
as  a  protection  against  this  irritation. 

"Of  the  clothing  furnished  at  present  for  active  cam- 
paigning I  have  found  that  the  light-gray  woollen  under- 
shirt of  light  weight,  with  an  overshirt  of  chambray  or 
gingham,   gives  comfort  and  satisfaction.      Personally  I 


CAMPS.  295 

have  found  the  most  comfort  from  the  gray  outing  flannel 
of  medium  weight,  worn  with  no  undershirt.  This  same 
material  of  a  khaki  color  would  be  still  better.  It  pre- 
vents chilling  ;  is  never  too  warm,  nor  sticks  to  the  body, 
but  absorbs  the  perspiration  and  dries  readily.  A  cotton 
undershirt  worn  under  this  while  in  camp  gives  one  the 
greatest  amount  of  comfort,  and  is  sufficiently  warm  for 
the  night.  As  the  nights  here  are  usually  cool,  sufficient 
covering  for  the  abdomen  must  be  worn.  For  this  the 
blue  flannel  shirt  answers  well  ;  in  fact,  it  has  become 
quite  customary  when  not  on  the  march,  but  lying  in 
camp,  for  the  soldiers  to  wear  the  blue  flannel  shirt  at 
night.  The  coolness  of  the  night  while  lying  down  is 
severely  felt  upon  the  abdomen  often  enough  to  keep  one 
awake  and  interrupt  his  rest.  Even  a  slight  covering  is 
a  help,  and  for  this  the  flannel  belly-band  is  worn.  The 
neglect  of  this  is  undoubtedly  the  predisposing,  if  not 
the  actual  exciting  cause  of  many  of  our  intestinal  ail- 
ments. 

"  The  white  jean  drawers  answer  all  conditions  at  all 
times;  they  are  loose,  comfortable,  and  safe. 

"  The  khaki  fatigue  uniforms  are  excellent. 

' '  During  the  wet  season  the  large  pouches  now  fur- 
nished are  of  more  service  than  the  rain  coat  or  mackin- 
tosh. They  protect  sufficiently  well  and  are  not  as  hot 
as  the  mackintosh;  besides  they  serve  as  a  blanket  or 
covering  at  night." 

Camps. — Tents. — The  tents  used  in  the  army  are  the 
hospital  tent,  the  officers'  wall  tent,  the  A-tent,  and  the 
shelter  tent,  which  is  a  modification  of  the  last.  Sol- 
diers give  the  preference  to  the  shelter  tent,  which  is 
light,  each  man's  piece  weighing  only  1.18  kilograms. 
Two  pieces  being  joined  together  by  buttons  and  button- 
holes, and  thrown  over  a  ridge  pole  supported  by  four 
uprights,  and^the  four  corners  fastened  to  pegs  driven  into 
the  ground,  form  a  tent  1.2  meters  high,  1.65  meters 
long,  and  having  a  spread  at  the  base  of  between  t.8  and 
2.1  meters.      Such  a  tent  will  form  a  comfortable  shelter 


296  MI  LI  TAR  Y  H  YGIENE. 

for  two  men,  unless  there  should  be  strong  winds  or 
drivino-  rains,  when  the  ends  should  be  closed  by  blankets 
or  an  extra  piece  of  shelter  tent.  The  uprights  and 
ridge  are  steadied  by  short  guy  ropes,  one  of  which  is 
furnished  with  each  piece  of  tent. 

Location  of  the  Camp. —  The  camp  should  not  be 
located  on  a  spot  that  has  recently  been  used  for  the 
same  purpose.  Camp  sites  should  also  be  frequently 
changed,  in  order  to  avoid  the  effects  of  soil  pollution 
which  might  result  from  long-continued  occupation. 
The  camp  site  should  be  selected  with  reference  to  sev- 
eral important  particulars.  The  soil  of  the  locality 
should  be  dry,  sandy  in  character,  and  well  drained.  The 
site  should  also  be  so  located  as  to  afford  a  plentiful  sup- 
ply of  pure  and  wholesome  water.  Too  much  stress 
cannot  be  laid  upon  this  point.  Low-lying,  damp,  or 
marshy  localities  should  be  avoided  for  obvious  reasons. 
The  camp  should  be  laid  out  in  regular  order  with 
streets,  so  as  to  provide  means  of  passing  freely  through 
the  camp.  The  camp  should  be  as  compact  as  will  be 
permissible  with  health  and  cleanliness. 

A  trench,  at  least  10  centimeters  in  depth,  should  be 
dug  around  each  tent,  so  as  to  exclude  surface  water,  and 
this  should  lead,  with  the  trenches  from  the  other  tents, 
into  a  larger  one  for  each  street,  so  as  to  conduct  the 
rain-water  from  the  camp-ground. 

Sanitary  Policing  of  the  Camp. — Frequently  this  mat- 
ter is  left  to  hired  civilians,  though  not  always.  The  camp 
streets  should  be  cleaned  regularly  every  day  and  all 
rubbish  burned  as  promptly  as  possible.  All  kitchen 
refuse  should  be  collected  twice  a  day  and  removed  from 
the  camp-grounds  or  buried  in  trenches  dug  for  the  pur- 
pose. The  tents  should  be  aired  each  day  by  opening 
the  doors  and  raising  the  walls  after  the  men  have  left 
them  in  the  morning.  All  bedding  should  likewise  be 
exposed  to  the  air  every  day  unless  the  weather  is  such  as 
to  prevent  it. 

Water-supply. — There  should  be  an  abundant  supply 


CAMPS. 


297 


of  pure  water  for  all  purposes  for  which  it  is  needed. 
Where  the  wholesomeness  of  the  water  is  doubtful,  some 
method  of  purification  should  be  provided.  For  this  pur- 
pose the  Forbes  portable  water  sterilizer  (Fig.  54)  is  now 
frequently  employed. 

This  apparatus  is  in  very  common  use  in  the  various 
army  camps  in  the  tropics,  and  the  universal  report  is 


FlG.  54. — Forbes'  portable  water  sterilizer,  army  type. 

most  favorable  as  to  its  efficiency  in  preventing  the 
development  of  typhoid  fever  and  diarrheal  diseases 
among  the  troops.  Even  in  localities  where  typhoid 
fever  prevailed  the  introduction  of  the  apparatus  and 
the  exclusive  use  of  boiled  or  sterilized  water  arrested 
the  outbreak. 


298  MILITARY  HYGIENE. 

A  board  of  army  surgeons,  consisting  of  Majors  Reed, 
Shakespeare,  and  Vaughn,  appointed  for  the  purpose  of 
testing  various  types  of  apparatus  submitted  to  the  war 
department  for  use  in  sterilizing  water  in  the  field,  report 
that  "all  living  micro-organisms,  except  a  few  spore- 
bearing  bacteria,  are  destroyed  by  the  degree  of  heat 
attained  during  the  passage  of  the  water  through  the 
apparatus.  The  disadvantage  of  the  escape  of  a  few 
spore-forming  bacteria  through  this  apparatus  is  con- 
sidered to  be  of  no  practical  importance  by  the  Board." 
They  also  found  that  "there  is  no  loss  of  the  natural 
gases  during  the  passage  of  the  water  through  the 
apparatus." 

Provision  should  be  made  of  ample  opportunities  for 
bathing.  In  the  absence  of  large  bodies  of  water  in  the 
vicinity  of  the  camp  permitting  the  soldiers  to  engage  in 
swimming,  shower-baths,  at  least,  should  be  supplied  at 
convenient  points  on  the  camping-ground. 

Latrines. — The  latrines  should  be  situated  from  140  to 
150  meters  to  the  leeward  of  the  camp.  A  deep  and  nar- 
row trench  should  be  dug  for  the  purpose.  It  must  not 
be  too  wide,  or  it  will  require  more  earth  to  cover  the 
excreta.  At  least  three  times  each  day  the  excreta  should 
be  covered  with  earth  to  a  depth  of  2  to  3  decimeters,  or 
with  slaked  lime.  The  dry  earth  readily  absorbs  the 
putrifying  material  and  thus  renders  it  inoffensive.  The 
bacteria  in  the  soil  destroy  the  organic  matter  contained 
in  the  excreta,  thus  rendering  them  harmless.  This  pro- 
cedure will  protect  the  excreta  from  flies  and  insects,  and 
limit  one  source  of  danger  of  general  infection  should 
there  be  unrecognized  cases  of  typhoid  fever  in  the  camp. 
The  excreta  of  all  cases  of  typhoid  fever  and  dysentery 
should  be  disinfected  at  once.  They  should  never  be 
thrown  into  the  trenches  without  this  precaution.  The 
excreta  in  the  trench  may  also  be  burned  daily  by  pour- 
ing kerosene  upon  them  and  applying  the  torch.  In  the 
tropics,  during  the  rainy  season,  the  dry-earth  closet  is 
being  used  for  hospitals  and  camps  in  towns.     The  excreta 


BARRACKS. 


299 


are  collected  in  galvanized  vessels,  covered  with  dry 
earth,  and  emptied  at  frequent  intervals.  New  sinks 
should  be  dug  when  the  old  ones  are  filled  to  within  6 
decimeters  of  the  top,  the  old  sinks  being  completely 
filled  with  earth. 

Barracks. — Besides  healthful  sites,  the  essential  con- 
ditions of  barracks  are  dryness,  warmth,  light,  amount 
of  floor  space,  and  air-supply. 

In  the  squad-room  each  man  should  have  at  least  30 
cubic  meters  of  air  space  and  465  square  decimeters  of 
floor  space,  and  south  of  36  degrees  north  latitude  the 
proportions  should  be  40  and  665,  respectively. 

There  should  be  more  space  allowed  if  the  barracks  are 
constantly  occupied,  because  the  dimensions  given  are 


Fig.  55. — Diagram  illustrating  ridge  ventilation. 

too  low  for  constant  occupation  during  active  exercise. 
The  official  recommendations  for  English  troops  in  India 
range  from  75  to  150  cubic  meters  of  air  space,  and  from 
620  to  1240  square  decimeters  of  floor  space. 

The  squad  room  should  be  not  less  than  35  decimeters 
nor  more  than  42. 5  decimeters  in  height,  and  preferably 
about  70  decimeters  wide.  Excessive  height  and  width 
should  be  avoided  because  of  greater  difficulty  in  efficient 
ventilation. 

Ridge  ventilation  is  perfectly  satisfactory  for  barracks, 


300  MILITAR  Y.  HYGIENE. 

or  it  may  be  accomplished  by  means  of  double  inlet  and 
outlet  tubes  in  the  roof  (see  Fig.  55),  so  constructed  that 
the  fresh  air  enters  through  the  outer  tube  and  the 
vitiated  air  takes  its  exit  through  the  inner  tube. 

There  should  be  ample  provision  for  bathing,  and  the 
water  supplied  as  pure  as  can  be  obtained.  If  its  purity 
is  open  to  question,  it  should  be  purified  by  sterilization, 
boiling,  or  filtration. 

The  latrines  require  careful  attention.  If  it  is  possible 
to  use  water-closets,  these  will  give  rise  to  least  difficulty. 
If  the  dry-earth  closet  system  is  employed,  the  receptacles 
should  be  emptied  at  frequent  intervals.  This  work  is 
often  delegated  to  civilians.  The  latrines  should  not  be 
near  the  kitchen  or  mess-room,  nor  near  the  sleeping- 
quarters  of  the  troops. 

The  kitchens  should  be  in  separate  buildings  from  the 
sleeping-quarters,  or  at  least  removed  from  them  as  far  as 
possible. 

When  numerous  cases  of  tonsillitis  occur  in  barracks, 
deficient  ventilation  may  always  be  suspected.  The 
accumulation  of  infective  dust,  along  with  vitiated  air  in 
barracks,  is  frequently  the  cause  of  tuberculosis  and 
pneumonia  among  troops. 

Marches. — The  effects  of  marches  are  dependent  upon 
the  distance  covered,  the  rate  of  travelling,  the  load 
carried  by  the  soldier,  the  condition  of  the  weather,  and 
the  character  of  the  roads.  An  important  influence 
upon  the  soldier  during  long  marches  is  the  length  of 
the  step  taken  and  the  number  of  steps  per  minute. 

At  the  end  of  each  hour  a  rest  of  at  least  five  minutes 
should  be  allowed.  This  will  permit  the  fatigued  soldier 
to  recuperate,  at  least  partially,  and  increases  his  endur- 
ance to  a  very  large  extent.  Whenever  possible,  marches 
should  be  made  before  ten  in  the  morning  or  after  five  in 
the  afternoon  if  the  weather  is  warm,  and  the  troops  should 
be  allowed  to  rest  during  the  hottest  part  of  the  day. 

The  canteens  are  to  be  filled  with  water  or  tea  before 
beginning  a  march,  but  no  fluid  should  be  drunk  while 


CAMP  DISEASES.  301 

marching,  or  as  little  as  possible,  and  then  only  in  small 
quantities  at  a  time. 

Under  ordinary  conditions,  both  in  cold  and  hot 
countries,  the  men  are  healthy  on  the  march.  But 
marches  are  sometimes  harmful  : 

1.  When  a  single  long  and  heavy  inarch  is  undertaken, 
when  the  men  are  overloaded,  without  food,  and  perhaps 
without  water. 

2.  When  the  marches,  which  singly  are  not  too  long, 
are  prolonged  over  many  days  or  weeks  without  rest. 

3.  When  special  circumstances  produce  disease. 
Camp  Diseases. — The  value  of  hygienic  measures  in 

the  army,  and  the  destructive  effects  of  diseases,  are 
clearly  shown  by  the  records  of  the  Civil  War  of  1861-65, 
when  the  casualties  of  battle  were  exceeded  fourfold  by 
the  deaths  caused  by  diseases,  the  most  important  and 
fatal  of  which  were  pneumonia,  typhoid  fever,  diarrhea, 
and  dysentery.  During  the  Spanish- American  War,  in 
spite  of  the  great  advancements  in  our  knowledge  of  the 
etiology  and  modes  of  dissemination  of  typhoid  fever,  a 
very  large  proportion  of  the  army  was  rendered  useless 
for  several  months  owing  to  the  prevalence  of  this  disease 
alone. 

The  close  companionship  entailed  by  the  military  ser- 
vice and  the  neglect  of  individual  cleanliness  are  largely 
blamable  for  the  wide  dissemination  of  typhoid  fever, 
diarrhea,  and  dysentery.  Under  these  conditions  it 
would  seem  a  much  greater  degree  of  personal  cleanli- 
ness is  necessary  than  in  private  life.  Another  factor  to 
be  considered  is  the  large  number  of  mild  cases,  the  so- 
called  "walking"  cases,  which  prevailed  in  some  of  the 
camps  during  the  late  war.  Aside  from  this  the  influence 
of  infected  dust  and  the  agency  of  flies  and  insects  must 
also  be  taken  into  consideration. 

Pneumonia  and  acute  bronchitis  are  more  prevalent 
during  the  winter  months,  and  these  are  traceable  to 
exposure,  dampness,  imperfect  nutrition,  insufficient 
clothing;    these   being   the   most  common   predisposing 


302  MILITAR  Y  H  YGIENE. 

factors.  Rheumatism  also  is  favored  by  the  same  predis- 
posing causes. 

In  certain  localities  malarial  fevers  also  prevail  to  a 
considerable  extent  among  soldiers.  This  has  been  the 
case  with  our  soldiers  in  the  tropics  in  the  last  two  years. 
The  preventive  measures  which  would  tend  to  render  a 
malarious  locality  healthful  are  draining  of  damp  soil, 
pouring  oil  upon  all  stagnant  bodies  of  water,  the  pro- 
tection of  the  soldier  by  means  of  mosquito-bars  wherever 
possible,  and  the  avoidance  of  exposure  after  nightfall. 

In  camps  composed  of  recently  enlisted  soldiers  measles 
is  very  likely  to  make  its  appearance.  Thus  far  no 
definite  mode  of  prevention  can  be  outlined  against  this 
disease  except  the  prompt  isolation  of  cases  as  they 
appear. 

Tuberculosis  is  also  prevalent  among  soldiers.  This 
is  the  case  in  both  camp  and  barrack,  though  in  the 
latter  it  is  encountered  most  frequently. 

Diseases  of  the  heart  and  blood-vessels  are  frequent  as 
the  result  of  the  strenuous  duties  of  the  soldier.  Long 
and  forced  marches  result  in  the  exhaustion  of  those  with 
a  weak  circulatory  apparatus. 

Venereal  diseases  are  always  prevalent  among  soldiers. 
The  prevention  of  these  diseases  is  a  most  difficult  matter, 
because  it  is  impossible  to  control  such  a  large  body  of 
men  in  their  moral  and  social  relations.  Some  good  may 
be  accomplished  by  banishing  all  known  prostitutes  from 
the  neighborhood  of  the  camp. 

Scurvy  is  far  less  frequent  than  formerly,  though  it  is 
not  unknown  even  at  the  present  day.  This  condition 
may  be  prevented  by  proper  regulation  of  the  food- 
supply,  since  it  is  known  to  be  a  disease  due  to  improper 
nutrition.  Fresh  vegetables  and  ripe  fruit  are  the  most 
serviceable  in  this  respect.  In  the  absence  of  sufficient 
supplies  of  these,  the  use  of  lime-juice  and  vinegar  will 
prove  of  great  value. 

Foot  Inspection. — In  the  German  army  the  feet  of 
the   soldiers    are   carefully   examined,    each   man's   feet 


BODY  INSPECTION.  303 

being  inspected  by  one  of  his  company  officers,  a  medi- 
cal officer,  and  the  lazareth  heifer,  at  least  twice  a  week 
in  barracks,  and  oftener  in  active  field  maneuvers. 
The  method  of  making  this  inspection  is  to  form  the 
companies  in  squads,  standing  upon  tables  or  benches 
sufficiently  high  to  bring  the  feet  directly  under  the  eye 
of  the  inspecting  officer,  and  to  bring  under  his  observa- 
tion any  wincing  or  flinching  when  the  inspected  man 
jumps  to  the  ground  barefoot.  The  inspecting  officer 
passes  down  the  line  carefully  examining  the  front  of  the 
feet  and  legs,  which  are  bared  to  the  knees,  searching  for 
strained  tendons,  blisters,  improperly  cut  nails,  or  un- 
trimmed  corns. 

Having  passed  down  the  line,  the  men  are  about-faced 
and  the  tendo-achilles  carefully  examined,  and  as  they 
raise  one  foot  and  then  the  other  the  soles  are  inspected. 
As  a  man  passes  from  the  table  or  bench  he  leaps  to  the 
ground  and  runs  to  his  shoes  and  stockings.  This  is  to 
show  any  bruised  soles  or  periostitis  of  the  tarsus.  Any 
cases  of  blisters,  improperly  cut  nails,  or  tenosynovitis 
are  at  once  cared  for  by  the  lazareth  heifer.  Those  with 
more  serious  disorders  are  sent  to  quarters  or  hospital. 

At  the  same  time  each  man's  socks  and  boots  are  care- 
fully inspected  as  to  the  degree  of  cleanliness.  As  the 
infantry  regiments  average  in  marching  a  kilometer  in 
ten  minutes,  being  often  pressed  to  a  kilometer  in  from 
seven  and  a  half  to  eight  minutes,  each  man  carrying  27 
kilograms,  this  care  of  feet  is  necessary.  When  tables 
or  benches  are  not  available,  the  trunk  of  a  fallen  tree  or 
a  block  of  stone  is  made  use  of. 

Body  Inspection. — The  entire  body  of  every  man  in 
the  German  army  is  inspected  by  a  company  officer  and 
a  medical  officer,  careful  search  being  made  for  any  heart 
lesion,  hernia,  venereal  disorder,  skin  disease,  eczema, 
etc.  This  is  in  order  that  any  physical  defect  that  might 
be  concealed  by  clothing  or  by  the  improper  modesty  or 
wilfulness  of  the  enlisted  man  may  be  carefully  noted, 
cared  for,   and  reported. 


CHAPTER    XIV. 
NAVAL  HYGIENE. 

The  term  naval  hygiene  usually  includes  all  that 
relates  to  maritime  life,  whether  relating  to  war  or  to 
commerce.  In  a  certain  sense  the  application  of  hygienic 
measures  to  such  a  small  and  isolated  community  as 
found  in  a  vessel  is  extremely  simple.  In  modern  ves- 
sels it  is  far  easier  than  in  those  of  even  a  decade  ago. 
The  improvements  in  construction,  arrangement,  and 
equipment  have  had  a  most  salient  influence  upon  the 
health  of  sailors  and  marines,  and  upon  the  comfort  of 
passengers. 

Though  there  have  been  important  advancements  in 
the  construction  and  arrangement  of  vessels,  it  is  still  a 
difficult  matter  to  supply  pure  air  in  sufficient  quantities, 
because  with  the  advancement  in  equipment  there  has 
been  no  relative  increase  of  the  air  space  available  for 
each  person.  The  air  space  on  shipboard  being  neces- 
sarily limited,  the  average  space  per  individual  can  only 
be  indirectly  increased  by  reducing  the  number  of  seamen 
to  the  lowest  point  permissible. 

The  vessel  should  be  as  large  as  possible  with  reference 
to  the  purpose  for  which  it  is  intended,  the  arrangement 
of  machinery  and  cargo  should  be  such  as  to  economize 
the  utilization  of  space,  and  the  size  and  location  of  the 
cabins  should  be  regulated  so  as  to  afford  a  maximum 
amount  of  space  for  each  person.  The  arrangement  of 
cabins  should  be  made  in  such  a  manner  that  it  may  be 
possible  to  secure  complete  isolation  of  any  cases  of  in- 
fectious disease  at  some  point  removed  from  the  seamen 
in  their  usual  duties.  The  amount  of  space  provided  for 
each  seaman  is  greater  than  -had  formerly  been  the  case, 
but  even  at   the  present  time  it   falls  below  theoretic 

304 


VENTILA  TION.  305 

standards.  The  hospital  cabins  should  be  of  greater 
space,  because  they  are  occupied  during  every  hour  of 
the  day.  These  quarters  should  not  be  located  in  the 
forecastle,  but  at  some  point  as  far  removed  from  the 
noise  of  the  machinery  as  possible. 

The  cubic  space  allotted  to  each  marine  on  war  vessels 
has  not  been  accurately  determined  and  no  data  are  avail- 
able on  this  point.  The  fact  that  marines  sleep  in 
hammocks  may  be  the  cause  of  supplying  a  somewhat 
greater  cubic  space  for  them  than  for  sailors  on  vessels  of 
commerce  where  hammocks  are  not  employed. 

With  regard  to  passenger  ships,  the  German  laws  direct 
that  each  between-deck  passenger  have  an  air  space  of  2.85 
cubic  meters,  and  a  floor  space  of  o.  25  square  meter.  For 
first-  and  second-class  passengers  no  directions  have  been 
made.  The  English  laws  direct  that  each  man  have  72 
cubic  feet  of  air  space,  and  12  square  feet  of  floor  space. 

Ventilation. — In  modern  vessels  propelled  by  steam 
the  introduction  of  forced  ventilation  by  means  of  fans 
or  steam  jets  is  a  comparatively  easy  matter.  In  this 
manner  a  definite  air-supply  can  be  assured,  either  by 
propulsion  of  fresh  air  or  extraction  of  the  vitiated  air. 
By  this  means  the  defects  arising  from  the  small  amount 
of  air  space  usually  supplied  can  be  remedied  to  a  great 
extent. 

According  to  information  derived  from  the  Bureau  of 
Construction  and  Repair  of  the  Navy  Department  of  the 
United  States,  "All  ships  of  war  are  ventilated  on  two 
principles,  natural  and  artificial.  Natural  ventilation  is 
obtained  through  hatches,  ventilating  ducts,  and  other 
openings  leading  directly  to  the  compartment  to  be  ven- 
tilated, and  depending  upon  a  supply  of  air  through 
cowls  which  are  turned  toward  the  wind.  All  living- 
spaces  are  further  ventilated  artificially,  either  by  means 
of  steam  or  electric  blowers,  which  supply  the  air  to  or 
exhaust  it  from  the  compartments  in  question.  Some 
compartments  are  fitted  with  both  supply  and  exhaust 
blowers,  but  in  general  only  one  system  is  fitted,  a  natural 
20 


306  NA  VAL  HYGIENE. 

exhaust  being  obtained  through  the  hatches  or  other 
openings  into  the  compartment. 

"  No  rules  can  be  given  for  the  cubic  meters  of  space 
allowed  per  man.  This  is  entirely  dependent  upon  the 
design  of  the  ship  and  the  number  of  men  carried.  The 
design  of  the  ventilating  system,  however,  is  such  as  to 
renew  the  air  in  various  spaces  in  certain  intervals  of 
time,  which  may  be  stated  approximately  as  follows: 
General  crew  space,  the  air  to  be  changed  once  in  eight 
minutes;  officers'  quarters,  once  in  twelve  minutes; 
engine-room  or  steering-engine  room  (where  the  air  is 
hot  and  vitiated),  once  in  two  minutes;  dynamo-room, 
once  every  three-fourths  of  a  minute. 

"The  supply  of  air  to  a  compartment  depends  not 
only  on  its  capacity  and  the  number  of  men  in  it,  but 
also  upon  the  temperature,  which  in  some  parts  of  the 
ship  is  excessively  high,  and  in  others  is  naturally  low. 
No  figures  on  efficiency  are  available." 

Dr.  Coppinger1  states  that  "the  question  of  air  space 
and  ventilation,  as  applied  to  men-of-war,  has  always 
been  a  difficult  problem,  and  the  progress  of  modern 
naval  architecture,  necessitated  by  altered  conditions  of 
warfare,  tends  in  many  ways  to  make  its  solution  more 
difficult  of  attainment.  Among  these  conditions  may  be 
mentioned  (i)  the  very  great  amount  of  air  space  occu- 
pied by  machinery  and  stores  connected  with  torpedo 
work,  and  (2)  the  introduction  of  water-tight  bulkheads. 
These  latter  partitions  are  a  great  source  of  difficulty  in 
respect  to  obtaining  complete  circulation  of  air  through- 
out the  ship. 

;'The  introduction  of  the  turret  and  barbet  system 
of  construction  into  battleships,  with  the  consequent 
reduction  and  almost  complete  abolition  of  apertures  for 
natural  ventilation  by  means  of  ports  and  hatchways, 
has  rendered  necessary  a  very  general  introduction  of  arti- 
ficial ventilation  by  means  of  rotary  fans,  to  supplement 
artificial  ventilation  by  means  of  funnel  and  funnel  casing. ' ' 

1  Trans.  Seventh  International  Congress  of  Hygiene. 


CLEANSING  THE   VESSEL.  307 

In  order  to  cool  the  air  between  decks  of  vessels  while 
in  the  tropics  it  has  been  suggested  that  this  might  be 
accomplished  by  means  of  compressed  air.  This  may  be 
utilized  both  as  a  source  of  motion  for  propelling  the  air 
and  also  to  abstract  heat  when  undergoing  expansion. 

Heating  of  the  Vessel. — The  application  of  steam  to 
navigation  makes  it  possible  to  utilize  the  exhaust  steam 
for  purposes  of  heating.  This  precludes  the  attempt  to 
heat  by  any  other  means,  and  affords  a  safe  and  satis- 
factory solution  to  this  problem,  which  formerly  gave 
rise  to  such  great  difficulties. 

lighting. — The  employment  of  electricity  on  board 
of  all  modern  vessels  of  any  great  size  makes  it  possible 
to  utilize  this  agent  entirely  for  the  purpose  of  lighting, 
and  so  removes  another  factor  once  so  great  in  rendering 
the  air  of  certain  parts  of  vessels  unhealthful. 

Cleansing-  the  Vessel. — The  excessive  use  of  water 
for  purposes  of  cleansing  should  be  prohibited.  It  was 
formerly  the  custom  to  keep  the  floors  constantly  soaked 
by  the  frequent  washing  of  the  ship,  thus  giving  rise 
to  a  most  unhealthful  condition  from  dampness.  A 
satisfactory  degree  of  cleanliness  can  be  maintained  with- 
out the  constant  application  of  copious  amounts  of  water, 
and  with  the  use  of  steam  for  heating  purposes  modern 
vessels  are  much  dryer  than  formerly,  and  consequently 
more  healthful. 

The  interior  of  iron  ships  is  apt  to  be  damp  on  account 
of  the  condensation  of  moisture  on  the  sides  of  the 
vessels.  The  prevention  of  the  condensation  of  moisture 
is  sought  through  the  application  of  paint  containing 
small  particles  of  cork,  or  a  cork  lining.  The  use  of 
wood  in  modern  warships  has  been  avoided  as  much  as 
possible  for  two  reasons:  First,  the  danger  from  fire;  and 
second,  the  disastrous  effects  from  splintering  of  the 
wood  by  perforating  shot.  The  first  objection  to  the  use 
of  wood  is  efficiently  removed  by  the  use  of  fire-proofing 
materials  which  have  lately  come  into  use,  but  the 
second  objection  remains. 


3o8 


NA  VAL  HYGIENE. 


Water-supply. — Great  care  should  be  exercised  in 
taking  on  board  a  supply  of  pure  and  wholesome  water 
for  culinary  purposes.  In  the  event  of  a  pure  water- 
supply  being  unavailable,  the  necessary  apparatus  should 
be  on  board  for  sterilizing  the  water  or  for  eeneratino- 
distilled  water.  Modern  war  vessels  are  provided  with 
facilities  for  bathing,  and  water-closet  arrangements. 
A  closet  should  be  supplied  for  each  thirty  to  fifty  pas- 
sengers. 

Food-supply. — In  the  case  of  ships  of  commerce  it  is 
comparatively  easy  to  maintain  a  fairly  satisfactory  sup- 
ply of  food.  In  the  case  of  war  vessels  the  State  supplies 
prescribed  rations,  which,  however,  can  be  supplemented, 
if  necessary,  by  additional  purchases  when  beyond  the 
base  of  supplies.  Moreover,  modern  war  vessels  are 
equipped  with  refrigerator  appliances,  so  that  fresh  meat 
and  vegetables  may  be  carried  long  distances. 

The  following  is  the  daily  ration  supplied  to  United 
States  marines,  based  upon  the  amounts  supplied  weekly  : 

Biscuit,  cornmeal  or  oatmeal 454  grams. 

Fresh  meat,  or 567 

Tinned  meat,  or 454 

Salted  beef  or  pork      340 

Peas,  beans,  or  tomatoes,  or 227 

Fresh  vegetables,  or 567 

Canned  vegetables 170 

Butter 24 

Coffee,  or 57 

Tea.,  or 14 

Cocoa 57 

Pickles 32 

Syrup 16 

Vinegar ^2 


The  diet  should  be  regulated  so  as  to  avoid  undue  mo- 
notony. The  harmful  influences  of  excessive  amounts 
of  salted  meat  should  be  overcome  by  the  use  of  refrigerated 
or  preserved  meats  and  the  use  of  sufficient  amounts  of 
vegetables  and  fruit.  Besides  guarding  against  the  use 
of  improper  proportions  of  certain  food  elements  at  all 
times,  it  is  necessary  to  adapt  the  dietary  to  the  climate 


SELECTION  OF  MARINES.  309 

as  well  as  to  the  nature  of  the  work  done  by  the  men. 
The  diet  should  at  all  times  be  sufficient  to  nourish  prop- 
erly the  men  under  whatever  external  conditions  they 
may  be  placed. 

Dr.  Henry  G.  Beyer1  calculates  that  the  regular  naval 
ration  affords  daily  142  gm.  nitrogenous  matter,  51  gm. 
fats,  and  398  gm.  carbohydrates. 

On  German  war-vessels  each  man  receives  daily  150 
gm.  nitrogenous  materials,  500  gm.  carbohydrates,  100 
gm.  fats,  35  gm.  salt.  In  the  German  navy  scorbutus  is 
prevented  by  giving  each  man  20  grams  of  citric  acid 
daily  when  the  voyage  is  longer  than  fourteen  days, 
especially  in  the  tropics. 

Clothing'. — The  clothing  of  marines  is  adapted  to  the 
climate  of  the  locality  and  the  season  of  the  year.  During 
hot  weather  white  duck  uniforms  are  worn,  while  in  cold 
weather  woollen  clothes  and  underclothes  are  supplied. 
In  the  navy  the  question  of  clothing  does  not  require  the 
same  degree  of  attention  and  forethought  as  is  often  the 
case  in  the  army,  because  each  individual  sailor  is  not 
required  to  carry  his  wardrobe  on  his  back  wherever  he 
goes. 

Selection  of  Marines.— In  the  selection  of  marines 
the  same  careful  physical  examination  is  necessary  as  in 
the  selection  of  recruits  for  the  army.  This  physical 
examination  is  directed  to  the  determination  of  the  ao-e. 
height,  weight,  chest  measurement,  sight,  and  hearing 
of  the  applicant.  As  the  result  of  the  careful  physical 
examination  of  the  nude  bodies  of  6129  lads  applying  for 
admission  to  the  U.  S.  Naval  Academy  at  Annapolis,- 
Dr.  Gihon  found  the  following  means  at  different 
ages  (see  page  310): 

Dr.  Gihon  concludes  that  at  every  age  there  is  a  lati- 
tude of  from  22.5  to  27  kilograms  in  weight,  17.7  to  21.8 
centimeters  in  height,  and  15.2  to  17.7  centimeters  in 
circumference  of  chest,  within  which  over  900  of  every 
1000  adolescents  will  be  found,  and  "it  must  be  recoo-- 

1  Proceedings  U,  S.  Naval  Institute,  p.  609,  1899. 


31® 


NA  VAL  HYGIENE. 


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SELECTION  OF  MARINES.  31 1 

nized  as  a  fact  that  perfect  health  and  bodily  vigor,  and 
the  development  peculiar  to  the  type  and  temperament 
of  the  individual,  are  not  inconsistent  with  an  average 
departure  below  the  mean  of  12  kilograms  in  weight,  10 
centimeters  in  height,  and  7.5  centimeters  in  circumfer- 
ence of  chest." 

Enlistment  of  boys  in  the  U.  S.  naval  service  is  made 
under  the  following  regulations: 

"  1.  Boys  between  the  ages  of  fifteen  and  seventeen 
years  may,  with  the  consent  of  their  parents  or  guardians, 
be  enlisted  to  serve  in  the  navy  until  they  shall  arrive 
at  the  age  of  twenty-one  years. 

"  2.  No  minor  under  the  age  of  fifteen  years,  no  insane 
or  intoxicated  person,  and  no  deserter  from  the  naval  or 
military  service  of  the  United  States,  can  be  enlisted. 

"3.  Boys  enlisted  for  the  naval  service  must  be  of 
robust  frame,  intelligent,  of  perfectly  sound  and  healthy 
constitution,  and  free  from  any  of  the  following  defects: 

"  Greatly  retarded  development;  feeble  constitution,  in- 
herited or  acquired;  permanently  impaired  general  health; 
decided  cachexia,  diathesis,  or  predisposition;  weak  or 
disordered  intellect;  epilepsy,  or  other  convulsions  within 
five  years;  impaired  vision  or  chronic  disease  of  the  organs 
of  vision;  great  dulness  of  hearing  or  chronic  disease  of  the 
ears;  chronic  nasal  catarrh;  ozena,  polypi  or  great  enlarge- 
ment of  the  tonsils;  marked  impediment  of  speech;  decided 
indications  of  liability  to  pulmonary  disease;  chronic 
cardiac  affections;  hernia  or  retention  of  testes  in  inguinal 
cavity;  circocele,  hydrocele,  stricture,  fistula,  or  hemor- 
rhoids; large  varicose  veins  of  lower  limbs,  scrotum,  or 
cord;  chronic  ulcers;  cutaneous  and  communicable  dis- 
eases; unnatural  curvature  of  the  spine,  torticollis  or 
other  deformity;  permanent  disability  of  either  of  the 
extremities  or  articulations  from  any  cause;  defective 
teeth;  the  loss  or  extensive  caries  of  four  molar  teeth. 

"4.  Physical  examinations  will  be  made  by  the  medi- 
cal officer  of  the  ship  upon  which  a  boy  presents  himself 
for  enlistment. 


312  NAVAL  HYGIENE. 

"  5.  Boys  must  have  the  following  heights  and  meas- 
urements: 

Chest  measurement, 
Age.  Height  not  less  than —    Weight  not  less  than —      breathing  naturally, 

not  less  than — 

Fifteen  years    .    .  4  feet  II  inches.  80  pounds.  27  inches. 

Sixteen  years    .    .  5  feet     1  inch.  90  pounds.  28  inches. 

"  6.   They  must  be  able  to  read  and  write. 

"7.  In  special  cases,  where  a  boy  shows  general  intel- 
ligence, and  is  otherwise  qualified,  he  may  be  enlisted 
notwithstanding  his  reading  and  writing  are  imperfect. 

"8.  Bach  boy  presenting  himself  for  enlistment  must 
be  accompanied  by  his  father,  or  by  his  mother  in  case 
the  father  be  deceased,  or  by  his  legally  appointed  guar- 
dian in  case  he  has  neither  father  nor  mother  livingf,  and 
the  parent  or  guardian  presenting  the  boy  must  sign  the 
prescribed  'Consent,  declaration,  and  oath,'  which 
forms  part  of  the  shipping  articles. 

"9.  In  cases  where  parents  or  guardians  may,  by 
reason  of  distance,  infirmity,  or  other  causes,  be  unable 
to  appear  at  the  place  of  enlistment,  they  will,  on  writ- 
ten application  to  the  commanding  officer  of  either  of 
the  ships  upon  which  enlistments  are  made,  be  furnished 
with  the  printed  form  of  '  Consent,  declaration,  and 
oath,'  in  duplicate,  by  executing  which  the  enlistments 
will  be  perfected,  should  the  boys  be  accepted  by  the 
board  of  examining  officers." 

The  enlistment  of  men  for  the  naval  service  is  made 
under  the  following  regulations: 

"The  term  of  enlistment  of  all  enlisted  men  of  the 
navy  shall  be  four  years.  No  enlistments  for  special 
service  are  allowed. 

"Minors  under,  but  claiming  to  be  over,  eighteen 
years  of  age,  are  liable,  if  enlisted,  to  punishment  for 
fraudulent  enlistment,  under  the  act  of  Congress  approved 
March  3,  1893. 

"  Only  such  persons  shall  be  enlisted  as  can  reasonablv 
be  expected  to  remain  in  the  service,  and  when  enlisted 
must  serve  out  the  terms  of  their  enlistment,  and  cannot 


SELECTION  OF  MARINES.  313 

be  discharged  except  by  purchase,  which  is  not  an  abso- 
lute right,  but  a  privilege  which  may  be  granted  under 
extraordinary  circumstances,  clearly  substantiated  to  the 
satisfaction  of  the  bureau  of  navigation. 

"  Every  person,  before  being  enlisted,  must  pass  the 
physical  examination  prescribed  in  the  medical  instruc- 
tions, and  no  person  shall  be  enlisted  for  the  naval  ser- 
vice unless  pronounced  fit  by  the  commanding  and  med- 
ical officers,  except  by  special  authority  in  each  case 
from  the  navy  department. 

"Any  of  the  following  conditions  will  be  sufficient  to 
cause  the  rejection  of  an  applicant:  Greatly  retarded 
development;  feeble  constitution,  inherited  or  acquired; 
permanently  impaired  general  health ;  depraved  condition 
of  general  nutrition;  liability  to  any  disease;  chronic 
disease  or  results  of  injuries  sufficient  permanently  to 
impair  efficiency,  such  as  weak  or  disordered  intellect; 
epilepsy  or  other  convulsions  within  five  years;  impaired 
vision  (less  than  ^0  in  either  eye);  disease  of  the  eyes; 
defective  color  sense;  or  chronic  disease  of  the  ears; 
chronic  or  offensive  nasal  catarrh;  tumors  of  the  nasal 
passages  or  great  enlargement  of  the  tonsils;  marked 
impediment  of  speech;  decided  indications  of  liability  to 
pulmonary  disease;  chronic  heart  affections;  rupture; 
non-appearance  of  testicles;  dropsy  of  testicles  or  cord; 
stricture,  fistula,  or  hemorrhoids;  large  varicose  veins  of 
lower  limbs,  scrotum,  or  cord;  chronic  ulcers;  cutaneous 
and  communicable  diseases;  unnatural  curvature  of  the 
spine;  wryneck  or  other  deformity;  permanent  disability 
of  either  of  the  extremities,  or  articulations  from  any 
cause;  defective  teeth;  the  loss  or  extensive  caries  of 
four  molar  teeth. 

' '  Each  recruit  shall  be  required  to  take  the  oath  of 
allegiance,  and  further  swear  that,  to  the  best  of  his 
knowledge  and  belief,  the  statement  he  makes  regarding 
his  date  of  birth  and  previous  naval  service  is  correct, 
and  that  he  is  not  subject  to  fits;  has  no  disease  concealed 


314  NA  VAL  HYGIENE. 

or  likely  to  be  inherited,  and  has  no  stricture  or  internal 
piles. 

"  Applicants  for  enlistment  must  be  American  citizens, 
native  or  naturalized,  and  must  be  able  to  read  and  write 
English. 

"  No  minor  under  the  age  of  fourteen  years,  no  insane 
or  intoxicated  person,  and  no  deserter  from  the  naval  or 
military  service  of  the  United  States  shall  be  enlisted  in 
the  naval  service. 

"  No  one  who  has  already  been  in  the  naval  or  military 
service  of  the  United  States  shall  be  enlisted  without 
showing  his  discharge  therefrom.  Should  it  be  claimed 
that  the  discharge  has  been  lost,  the  circumstances  shall 
be  reported  to  the  navy  department. 

"  Beneficiaries  who  have  been  admitted  to  the  Naval 
Home,  and  pensioners,  shall  not  be  enlisted. 

"Any  person  with  a  continuous-service  certificate 
which  is  endorsed  "discharged  with  a  bad-conduct  dis- 
charge," "dishonorably  discharged,"  or  "not  recom- 
mended for  re-enlistment,"  shall  not  be  re-enlisted. 

"  Fraudulent  enlistment,  and  the  receipt  of  any  pay  or 
allowance  thereunder,  are  offences  against  naval  disci- 
pline, and  are  punishable  by  general  court-martial  (Act 
approved  March  3,  1893). 

"On  first  enlistment  men  must  be  between  the  follow- 
ing ages: 

Rating.  Years  of  age.  Rating.  Years  of  age. 


Seamen 21  to  35 

Ordinary  seamen 18  "  30 

Landsmen    . iS  "  25 

Shipwrights 21  •  "  35 

Blacksmiths 21  '•  35 

Plumbers  and  fitters    .    .    .    .  21  "  35 

Sailmakers'  mates 21  "  35 

Machinists,  first  class  .  .  .  21  "  35 
Machinists,  second  class  .  .  21  "  35 
Electricians,  third  class      .    .  21  "  35 

Boilermakers 21  "  35 

Coppersmiths 21  "  35 

Firemen,  first  class      .    .    .    .  21  "  35 


Firemen,  second  class     .    .    .  21  to  35 

Coal-passers 21  ''  35 

Hospital  stewards 21  "  30 

Hospital  apprentices,  1st  class  18  "  25 
Hospital  apprentices,  2d  class   iS  "  25 

Officers'  stewards 21  "  35 

Officers'  cooks 21  "  35 

Mess  attendants 18  "  30 

Ships'  cooks,  fourth  class  .  .  18  "  30 
Musicians,  first  class  .  .  .  .  21  "  35 
Musicians,  second  class      .    .  21  "  35 

Buglers 21  "  35 

Painters 21  "  35 


PRINCIPAL  DISEASES  AMONG  MARINERS.     315 

"Minimum  height  for  ratings  herein  mentioned,  5 
feet  and  4  inches,  stripped;  the  candidate  should  be  well 
developed,  considering  his  age  and  height. 

"  Persons  possessing  a  mechanical  trade  may  be  enlisted 
even  if  over  twenty-five,  provided  they  are  under  thirty- 
five  years  of  age.    ■ 

"  No  person,  except  an  honorably  discharged  ex-appren- 
tice, shall  be  enlisted  as  a  seaman  unless  he  shall  have 
been  four  years  at  sea,  nor  as  an  ordinary  seaman  unless 
he  shall  have  been  two  years  at  sea  before  the  mast.  In 
both  cases  applicants  shall  be  required  to  pass  a  satis- 
factory examination. ' ' 

The  general  appearance  of  the  applicant  is  also  taken 
into  consideration,  and  those  that  are  uncleanly  in  their 
person  or  attire  are  discarded  because  they  prove  in- 
capable of  efficient  training. 

Recently  the  character  of  the  teeth  in  applicants  for 
both  the  naval  and  military  .service  has  been  taken 
into  consideration.  It  is  evident  that  a  man  whose  grind- 
ing and  biting  capacity  is  seriously  impaired  will  more 
readily  suffer  from  gastro-intestinal  trouble  than  one  with 
a  full  set  of  perfect  teeth.  The  loss  of  five  teeth,  absent 
or  unsound  in  any  degree,  is  usually  considered  as  cause 
for  rejection  ;  even  the  loss  of  three  or  four  molars  or  in- 
cisors in  the  same  jaw  is  sufficient  to  render  a  young  man 
unfit  for  service  in  the  navy. 

Principal  Diseases  among  Mariners. — The  average 
strength  of  the  active  list  of  the  U.  S.  Navy  for  the  year 
1899  was  20,019.  The  total  number  of  admissions  for 
disease  was  12,794,  and  for  injuries  2955,  giving  a  ratio 
per  1000  of  strength  of  636.11  and  146.92,  respectively. 
During  the  year  there  were  admitted  to  the  sick  list,  of 
the  total  force — 


Malarial  diseases     . 
Diarrheal  affections 

Wounds 

Rheumatic  affections 
Bronchial  affections 


943  cases. 
900      '' 
884      " 
716      " 
685      » 


Epidemic  catarrh     ....  672  cases. 

Dengue 297      " 

Alcoholism 193      " 

Heat-stroke 154      " 

Typhoid  fever 134     " 


316 


NA  VAL  HYGIENE. 


Pneumonia 1 17  cases. 

Pulmonary  tuberculosis  .    .       87      " 

Dysentery 68      " 

Organic  heart-disease     .    .  42      " 

Measles 37      " 


Nephritis 31  cases. 

Scarlet  fever 29      " 

Yellow  fever 8      " 

Small-pox 6      " 


Of  the  943  cases  of  malarial  diseases,  nearly  one-third 
were  from  the  navy-yard  and  marine  headquarters,  Wash- 
ington, D.  C.  ;  of  the  134  cases  of  typhoid  fever  reported 
during  the  year,  49  were  under  treatment  in  the  naval 
hospital,  Newport,  R.  I.  Of  this  number,  45  originated 
among  the  personnel  of  the  training  station,  1  was  re- 
ceived from  the  torpedo  station,  and  3  from  ships  of  the 
North  Atlantic  squadron. 


CHAPTER   XV. 
SOIL. 

The  nature  of  the  soil  in  its  relation  to  health  is  an 
important  subject.  The  relation  of  the  soil  of  a  locality 
to  the  public  health  is  dependent  upon  its  intimate  struct- 
ure. Soils  are  composed  of  varying  proportions  of  min- 
eral, vegetable,  and  animal  constituents.  These  constitu- 
ents vary  in  size  not  only  in  different  localities,  but  even 
in  the  same  locality.  The  interstices  of  the  soil  are  filled 
either  with  air  or  with  water.  A  soil  is  moist  or  dry 
according  to  the  preponderance  of  small-  or  large-sized 
soil-particles.  The  finer  and  more  uniform  the  soil- 
particles,  the  greater  the  amount  of  moisture  usually 
contained  in  the  soil. 

All  soils  are  porous,  and  contain  varying  amounts  of 
air  and  moisture.  The  relation  of  the  soil  to  health  is 
influenced  by  the  amount  and  nature  of  the  contained  air 
and  water.  The  degree  of  purity  of  the  ground-air  and 
ground-water  is  influenced  by  the  amount  and  nature  of 
the  vegetable  and  animal  organic  matter  contained  in  the 
soil,  and  the  temperature  of  the  locality — whether  favor- 
able or  unfavorable  to  the  decomposition  of  organic 
matter  through  the  agency  of  bacteria. 

Ground-air. — Ground-air  is  usually  rich  in  carbon 
dioxid,  derived  from  decomposing  organic  matter  in 
the  soil.  It  is  also  very  moist,  because  there  is  usually 
plenty  of  opportunity  to  take  up  moisture.  It  also  con- 
tains decomposition-products,  such  as  marsh-gas,  hydro- 
gen sulphid,  and  ammonia.  This  air  is,  consequently, 
not  suitable  for  respiratory  purposes.  The  amount 
of  soil-air  that  gains  access  to  houses  under  ordinary 
conditions  is,  however,  so  small  that  its  influence  prob- 

317 


318  SOIL. 

ablv  is  not  felt.  In  newly  made  soils,  in  which  there  is 
considerable  decaying  organic  matter,  there  is  some 
danger  of  the  entrance  of  large  amounts  of  ground-air 
into  houses  built  on  such  soils  unless  special  provision 
is  made  to  exclude  it.  In  such  houses  there  should  be 
cemented  foundation  walls  and  cellars,  and  the  supply 
of  fresh  air  should  be  derived  from  the  outside  at  some 
distance  above  the  ground.  Unless  the  foundation  walls 
and  cellars  are  cemented,  the  houses,  when  warmed,  may 
serve  as  an  immense  chimney  in  extracting  the  air  from 
the  surrounding  soil. 

Ground-water. — Ground-water  is  rain-water  that  has 
fallen  upon  the  soil  of  the  locality  and  penetrated  its 
surface.  It  differs  from  stored  rain-water  according  to 
the  nature  of  the  soil  constituents.  It  is  richer  in  dis- 
solved solids,  and  contains  also  the  products  of  de- 
composition derived  from  decaying  organic  matter  in 
the  soil.  It  contains  also  numerous  bacteria  derived 
from  the  soil.  The  relation  of  ground-water  to  health  is 
directly  dependent  upon  the  presence  or  absence  of  patho- 
genic bacteria  in  the  soil,  and  the  presence  or  absence 
of  mineral  constituents  derived  from  the  soil  which  may 
be  injurious  to  health,  such  as  salts  of  calcium,  magne- 
sium, or  iron. 

Pettenkofer's  theory  of  the  relation  of  soil  moisture  to 
typhoid  fever  and  cholera  is  no  longer  tenable.  We 
know  now  that  the  height  of  the  level  of  the  ground- 
water has  no  direct  influence  in  the  production  of  either 
of  these  two  diseases.  There  is  evidently  an  indirect 
relation  between  low  ground-water  and  the  development 
of  these  diseases,  because  at  such  times  the  drainage  area 
of  all  wells  is  increased,  and  the  polluting  material  in  or 
upon  the  soil  of  a  corresponding  greater  area  is -conducted 
into  the  well.  In  the  same  manner,  when  drinking- 
water  is  derived  from  streams  there  is  greater  oppo~- 
tunity  for  the  entrance  of  concentrated  polluting  matter 
into  the  stream,  and  it  exists  there  in  a  more  concentrated 
form  than  in  times  of  flood. 


GROUND-  WA  TER.  319 

The  relation  of  a  damp  soil  to  the  greater  prevalence 
of  consumption,  as  originally  pointed  out  by  Bowditch, 
cannot  be  regarded  as  a  direct  one.  The  damp  soil  prob- 
ably predisposes  to  colds  and  diseases  of  the  lungs,  and 
thus  paves  the  way  for  the  contraction  of  consumption. 
There  is  thus  far  no  evidence  that  the  bacillus  of  tuber- 
culosis is  capable  of  multiplying  in  damp  soils. 

The  relation  of  damp,  marshy  soils  to  malaria  has 
received  a  great  deal  of  elucidation  in  the  last  few  years. 
It  is  believed  at  the  present  time  that  the  malarial  organ- 
ism is  contracted  most  frequently,  if  not  entirely,  through 
the  sting  of  a  particular  species  of  mosquito — Anopheles. 
These  mosquitoes  are  usually  indigenous  to  the  soil  of 
certain  marshy  localities,  but  thus  far  no  definite  relation 
between  the  nature  of  the  soil  of  these  localities  and 
the  prevalence  of  mosquitoes  has  been  demonstrated. 
The  fact  that  many  localities  were  formerly  foci  of 
malaria  would  indicate  that  they  were  infested  with  these 
same  mosquitoes,  and  that,  from  some  unexplained  cause, 
they  became  healthful.  Marshy  localities,  when  drained 
so  as  to  prevent  the  development  of  mosquitoes,  also 
become  healthy  and  free  from  malaria.  Where  drainage 
is  impossible,  it  is  believed  that  the  application  of  some 
antiseptic,  such  as  crude  petroleum,  to  the  marsh  will 
prevent  the  development  of  the  mosquitoes  and  thus 
eradicate  malaria  from  those  localities.1 

Damp  soils  are  likely  to  be  productive  of  diarrheal  dis- 
eases, though  these  affections  are  most  probably  brought 
about  by  certain  bacteria  in  the  soil  along  with  the  detri- 
mental influence  of  the  dampness  itself.  The  amount  of 
decaying  organic  matter  in  and  upon  the  soil  is  most 
probably  in  direct  relation  to  the  prevalence  of  diarrheal 
diseases  in  a  locality. 

In  the  same  manner  the  amount  of  moisture  in  the 
soil  will  influence  the  prevalence  of  other  diseases,  such 
as  rheumatism,  bronchitis,  pneumonia,  and  the  exanthem- 

1  Recent  studies  in  Africa  indicate  that  probably  other  diseases,  especially 
elephantiasis,  are  conveyed  by  species  of  mosquitoes. 


320  SOIL. 

ata.  The  relation  of  soil  moisture  to  these  diseases  is 
probably  only  an  indirect  one  in  that  it  favors  the  main- 
tenance of  the  life  of  the  morbific  agents  by  preventing 
drying. 

Pathogenic  Bacteria  in  Soil.— Some  of  the  patho- 
genic bacteria  are  apparently  capable  of  living  in  the  soil 
for  a  long  time,  and  some  of  them  may  even  be  able  to 
multiply  in  the  soil.  Among  these,  the  bacillus  anthra- 
cis,  the  bacillus  tetani,  and  the  bacillus  of  malignant 
edema  are  perhaps  most  capable  of  subsisting  in  the  soil 
because  of  their  faculty  of  passing  into  the  spore  stage. 
The  bacillus  enteritidis  sporogenes  of  Klein  may  also  be 
included  in  this  class. 

The  bacillus  typhosus  and  the  cholera  organism  are 
less  tenacious,  and  die  after  a  time  through  the  detri- 
mental influence  of  the  soil  organisms.  The  bacillus 
tuberculosis  can  remain  alive  in  soil  for  some  time  when 
protected  from  the  influence  of  soil  organisms,  though 
the  danger  of  infection  through  polluted  soil  is  a  remote 
one.  The  pyogenic  cocci  and  the  diphtheria  bacillus 
cannot  exist  in  the  soil  for  any  length  of  time  unless 
protected  from  the  influence  of  the  soil  organisms. 

Improvement  of  a  Damp  Soil.— A  damp  soil  may 
be  improved  by  opening  the  outflow  or  by  laying  a  sys- 
tem of  underground  drains.  The  construction  of  sewers 
often  serves  to  drain  the  soil  to  a  considerable  extent 
because  the  ground-water  follows  the  outside  of  the 
sewer. 

Configuration  of  the  Surface  and  Soil-covering. — 
Aside  from  the  intrinsic  nature  of  the  soil  itself,  and  the 
character  and  amount  of  air  and  water  contained  in  its 
interstices,  the  healthfulness  of  a  soil  is  influenced  also 
by  the  configuration  of  the  surface,  the  condition  of  the 
surface,  and  the  nature  of  the  soil-covering.  With  re- 
gard to  the  configuration  of  the  surface,  it  may  be  said 
that,  as  a  rule,  highlands  are  more  healthful  than  low- 
lands. The  degree  of  healthfulness  of  lowlands  is  influ- 
enced by  the  nature  of  the  soil  composing  them.     The 


SURF  A  CE  AND  SOIL-  CO  VERING .  32 1 

condition  of  the  surface  of  the  soil  with  regard  to  soil-cover- 
ing which  is  least  healthful  is  what  is  known  as  a  desert. 
Here  the  soil  is  exceedingly  dry  and  cannot  be  cultivated. 
Cultivated  areas  and  areas  covered  with  forests  are  more 
healthful,  because  the  soil  is  shaded  and  thus  the  heating- 
effect  of  the  sun's  rays  is  partly  excluded.  Cultivated 
areas  that  are  thickly  populated  are  less  healthful  because 
of  the  organic  impurities  which  gain  access  to  the  soil. 
The  soil  of  cities  can  be  maintained  in  a  comparatively 
healthful  condition  only  by  systematic  drainage,  so  as  to 
carry  away  all  the  organic  impurities  without  contami- 
nating the  soil,  air,  or  drinking-water. 
21 


CHAPTER   XVI. 
HABITATIONS. 

The  first  consideration  in  the  selection  of  a  site  for  a 
habitation  is  the  nature  of  the  soil  with  regard  to  damp- 
ness and  organic  impurity,  since  these  are  the  principal 
factors  in  rendering  a  soil  unhealthful.  The  house 
should  stand  upon  a  site  the  subsoil  of  which  is  naturally 
dry,  or  is  properly  drained  and  free  from  impurity.  The 
configuration  of  the  surface,  the  elevation,  and  the  ex- 
posure are  important  features  in  rendering  the  locality 
favorable  for  a  healthy  habitation.  The  nature,  source, 
and  amount  of  the  water-supply  should  be  investigated. 
The  possibility  for  the  economic  and  safe  disposal  of  all 
refuse  matter  must  also  be  considered.  The  locality 
should  be  sufficiently  elevated  to  secure  good  drainage 
away  from  the  house.  A  southern  exposure  is  preferable, 
especially  in  colder  climates.  The  proximity  of  large 
bodies  of  water  and  of  marshy  areas  also  influences  the 
healthfulness  of  the  locality. 

The  habitation  should  be  so  situated  with  relation  to 
others  surrounding  it  that  an  abundant  supply  of  fresh 
air  and  sunlight  can  be  secured.  The  healthful  influences 
of  sunlight  and  fresh  air  cannot  be  ignored.  The 
absence  of  sunlight  and  deficiency  of  fresh  air  are  the 
most  important  factors  in  producing  disease  in  the  homes 
of  the  poorer  classes  in  our  large  cities. 

Position  of  the  House.— If  possible,  the  house, 
especially  when  located  on  open  ground,  should  face  the 
south  or  west,  in  order  to  secure  the  greatest  amount  of 
sunlight  in  that  portion  of  the  house  most  constantly 
occupied.  The  windows  require  protection  with  blinds 
and  awnings  in  summer,  to  exclude  the  heat  and  glaring 

322 


THE  ROOF. 


323 


effect  of  the  sun;  but  in  winter  the  full  and  free  action 
of  sunlight  should  be  secured,  at  least  during  a  part  of 
each  day,  because  of  its  purifying  influence  upon  the  air 
of  the  house. 

Foundation  and  Walls.— The  foundations  and  walls 
should  be  as- dry  as  possible,  and  in  damp  soils  this  can 
be  secured  only  by  draining  the  subsoil  below  the  founda- 
tions, and  by  cementing  the  foundation  walls  and  cellar 
floor.  If  there  is  no  cellar,  the  floors  should  be  raised 
about  0.5  meter  above  the  ground,  so  as  to  secure  thor- 
ough ventilation  beneath  the  floor.    Dryness  of  the  walls 


FlG.  56. — Double  foundation  walls. 

is  best  secured  by  means  of  hollow  walls  (Fig.  56),  or  by 
coating  the  walls  with  cement  or  slate.  Bricks  are  quite 
porous  and  absorb  a  great  deal  of  moisture,  and  thus 
render  the  walls  damp.  Stone  also  is  porous  and  retains 
moisture  for  a  long  time,  consequently  stone  houses  are 
liable  to  be  damp. 

The  Roof. — The  roof  of  the  house  must  be  carefully 
constructed  and  frequently  examined  in  order  to  prevent 
leaking.  The  material  composing  the  roof  is  of  no  vital 
importance  so  long  as  it  excludes  rain.  The  rain-water 
falling  upon  the  roof  should  be  conducted  away  from  the 


324  HABITA  TIONS. 

house,  so  as  to  prevent  the  soil  of  the  locality  from  be- 
coming unduly  damp  from  this  cause. 

The  Interior  Arrangement. — The  interior  of  the 
house  should  be  arranged  so  as  to  afford  the  greatest 
facility  for  the  use  of  every  part  of  it  for  the  purposes  for 
which  it  is  intended.  The  stairways  should  be  wide  and 
the  steps  broad,  with  easy  slope,  so  as  to  prevent  fatigue 
as  much  as  possible  in  going  from  one  floor  to  another. 
The  rooms  on  each  floor  should  communicate  with  each 
other,  or  with  a  common  hallway,  so  as  to  favor  easy 
access  and  insure  more  efficient  ventilation. 

Si^e  of  the  Rooms. — The  size  of  the  rooms  is  a  mat- 
ter of  the  greatest  importance  in  maintaining  the  purity 
of  the  contained  air.  The  detrimental  influence  of  in- 
sufficient air  space  is  well  known.  The  point  of  greatest 
hygienic  importance  is  not  how  many  rooms  a  person  has, 
but  how  much  room.  A  small  room  may  be  overcrowded 
with  a  single  person  in  it,  while  a  large  room  is  not 
overcrowded  with  four  to  six  persons  in  it.  Aside  from 
the  matter  of  cubic  space,  the  question  of  the  dimensions 
of  the  room  is  of  the  greatest  importance.  The  minimum 
amount  of  cubic  space  allowable  for  sleeping-rooms  per 
adult  person  is  10  cubic  meters,  though  a  room  of  25 
cubic  meters  is  far  more  desirable.  It  is  evident  that  a 
room  3  meters  high  is  far  more  easily  ventilated  than  one 
that  is  10  meters  high  with  the  same  amount  of  air  space. 
Sleeping-rooms  should  be  at  least  2.75  meters  high, 
though  a  height  much  in  excess  of  3  meters  is  not 
desirable.  A  room  less  than  2  meters  in  height  is  not 
suitable  for  a  sleeping-room.  The  floor  space  of  a  sleep- 
ing-room should  be  at  least  3  square  meters.  The  living- 
rooms  of  a  house  should  possess  a  cubic  space  of  at  least 
12  cubic  meters  for  each  occupant,  though  an  allowance 
of  30  cubic  meters  is  preferable. 

If  the  arrangements  for  ventilation  are  efficient,  the 
air  will  require  to  be  changed  about  three  times  an  hour 
in  a  room  of  25  to  30  cubic  meters  capacity,  while  in  a 
room   of  only   10  to   12   cubic  meters  the  air  must   be 


THE  FLOORS  AND  FLOOR  COVERINGS.         325 

changed  seven  to  eight  times  an  hour  in  order  to  main- 
tain its  purity.  The  living-rooms  of  a  house  should  be 
correspondingly  larger  than  the  sleeping-rooms,  in  order 
to  accommodate  the  larger  number  of  persons  occupying 
them,  and  the  greater  amount  of  exhalation  from  the 
body,  and  the  greater  amount  of  impurity  derived  from 
heating  and  lighting.  It  has  been  estimated  that  every 
lighted  gas-burner  requires  from  12  to  15  cubic  meters 
of  fresh  air  per  hour  in  order  to  prevent  an  undue  amount 
of  pollution  of  the  air  of  a  room  from  this  source,  and 
to  maintain  the  standard  of  purity. 

The  Sleeping-rooms.— La  wson  Tait,  in  a  recent 
paper,  gives  his  views  on  bed-rooms  and  bed-room  furni- 
ture, based  on  a  lifelong  experience  and  observation. 
He  directs  that  the  bed-room  shall  have  a  capacity  of  56 
cubic  meters,  with  tight-fitting  doors  and  windows,  and 
a  ventilating  flue  of  at  least  1.5  decimeters  in  diameter. 
The  window-panes  should  be  of  plate  glass  to  prevent 
the  too  rapid  cooling  of  the  air  of  the  room.  He  advises 
the  construction  of  houses  with  double  walls,  with  an  air 
space  between  them  of  at  least  0.75  decimeter,  in  order 
to  prevent  dampness  of  the  walls.  If  possible,  the  room 
should  be  warmed  by  means  of  gas,  as  this  is  the  best 
means  of  maintaining  a  uniform  temperature.  He  directs 
that  the  bedstead  shall  be  of  steel  or  iron,  2  meters  in 
length,  and  of  a  width  sufficient  to  accommodate  only 
one  person.  Two  such  bedsteads  should  be  placed  side 
by  side.  The  danger  of  communicating  such  a  disease 
as  consumption  from  one  person  to  another  while  sleep- 
ing together  is  quite  evident.  The  healthfulness  of 
single  beds  is  generally  recognized,  though  in  America, 
as  in  England,  they  are  not  in  very  common  use. 

The  Floors  and  Floor  -  coverings. —  Hard -wood 
floors  are  to  be  preferred,  because  they  are  less  pervious 
to  dust  and  therefore  more  easily  kept  in  a  sanitary  con- 
dition. 

The  covering  of  the  floors  of  a  house  has  an  important 
influence  upon  its  healthfulness.     Carpets  and  matting 


326  HABITATIONS. 

are  objectionable,  because  they  are  fastened  to  the  floor 
and  are  allowed  to  remain  in  place  for  months  or  even 
years.  It  is  preferable  to  have  the  floors  painted  and 
covered  with  a  rug  that  can  be  removed,  aired,  and 
cleaned  at  frequent  intervals. 

The  Wall-covering.— The  covering  of  the  walls  of 
rooms  is  a  matter  of  the  greatest  importance.  Wall- 
paper or  paint  of  a  bright-green  or  red  color  should  be 
avoided,  because  these  colors  may  contain  arsenic.  The 
arsenic  in  wall-papers  will  eventually  become  detached 
and  be  present  in  the  air  of  the  room  as  arsenical  vapor. 
Sufficient  arsenic  has  been  found  in  the  air  of  rooms, 
derived  from  these  sources,  to  produce  poisonous  effects 
in  those  constantly  breathing  the  air.  The  custom  of 
placing  a  new  layer  of  wall-paper  on  the  old  and  soiled 
paper  cannot  be  condemned  too  vigorously.  This  custom 
is  very  generally  practised  in  spite  of  repeated  remon- 
strances and  warnings  of  the  danger  involved.  All  the 
filth  contained  on  the  old  paper  is  allowed  to  remain  on 
the  walls,  and  is  simply  covered  over  with  another  layer 
of  paper.  This  goes  on  until  the  number  of  layers  of 
paper  is  so  great  that  its  weight  prevents  it  from  adhering 
to  the  walls  any  longer.  Whenever  a  room  needs  paper- 
ing, the  old  paper  should  be  carefully  removed  and  the 
walls  scraped  before  a  layer  of  new  paper  is  placed  upon 
them. 

The  prevalence  of  tuberculosis  in  certain  houses  year 
after  year  and  generation  after  generation  can  be  traced, 
at  least  in  considerable  part,  to  this  custom  of  repapering 
the  walls,  as  well  as  to  neglect  of  disinfection  and  cleans- 
ing after  death  or  removal  of  a  case  of  tuberculosis.  This 
condition  will  continue  until  compulsory  registration  of 
all  tubercular  patients  is  secured.  The  tubercle  bacillus 
is  capable  of  existing  in  the  dust  of  rooms  for  a  long 
time,  and  the  inhalation  of  this  infectious  dust  by  sus- 
ceptible persons  is  no  doubt  a  frequent  source  of  infec- 
tion. When  moving  into  an  old  house,  therefore,  it  will 
be  safest  to  give  it  a  thorough  cleansing  and  disinfection, 


VENTILA  TION  AND  HE  A  TING.  327 

to  prevent  the  contraction  of  disease  from  infected  dust 
and  the  soiled  walls  and  woodwork  of  the  house. 

It  is  preferable  to  have  the  walls  painted,  in  order  that 
they  may  be  cleaned  and  disinfected  without  injury. 
Where  the  delicate  nature  of  the  wall  paint  does  not  per- 
mit efficient  cleansing  and  disinfection  a  fresh  coat  of 
paint  should  be  applied  instead.  This  will  serve  to  dis- 
infect the  walls  in  an  efficient  manner. 

Ventilation  and  Heating". — When  a  general  system 
of  heating  and  ventilation  is  employed,  by  means  of  a 
furnace  or  indirect  heating  by  means  of  steam,  provision 
should  be  made  for  securing  pure,  fresh  outside  air.  The 
more  or  less  stagnant  air  of  the  cellar  should  not  be 
employed  for  this  purpose.  Ventilating  flues  of  appro- 
priate size  should  lead  to  each  of  the  rooms,  so  that  the 
ventilation  of  each  may  be  independent  of  every  other 
part  of  the  house.  Provision  must  also  be  made  for  the 
escape  of  the  impure  air  from  each  room,  a  matter  which 
is  very  frequently  neglected. 

When  the  rooms  are  heated  by  direct  radiation  of  some 
form  or  another  it  is  still  necessary  to  provide  for  the  en- 
trance of  fresh  air.  In  such  a  system  of  heating  the  out- 
side air  cannot  always  be  brought  in  at  the  desired  tem- 
perature, and  it  becomes  necessary  to  provide  special 
devices  for  bringing  in  the  fresh  air  without  creating 
draught.  The  fresh  air  cannot  be  brought  in  by  simply 
opening  the  windows  without  creating  draughts.  The 
simplest  method  is  by  placing  a  board  underneath  the 
lower  sash,  so  as  to  allow  the  air  to  enter  between  the 
lower  and  upper  sash.  By  this  means  the  incoming  air 
will  continue  its  upward  course  and  become  distributed 
through  the  upper  portion  of  the  room.  A  number  of 
devices  have  been  invented  to  bring  about  the  same 
results  without  the  use  of  a  board  beneath  the  lower 
sash,  among  which  are  perforated  window-panes,  and  an 
upper  sash  that  slopes  inward.  Fresh  air  may  also  be 
admitted  through  special  openings  in  the  walls,  but  in 
this  method  it  is  necessary  to  conduct  the  incoming  air 


328  HABITA  TIONS. 

upward  toward  the  ceiling,  so  as  to  avoid  draught.  The 
mouth  of  inlet  openings  should  always  be  high  enough 
to  prevent  the  current  of  air  impinging  on  the  occupants 
of  the  room.  In  order  to  secure  efficient  ventilation 
where  the  system  of  indirect  heating  is  employed,  it  is 
necessary  to  provide  exit  openings  for  the  impure  air  in 
the  room. 

Plumbing  and  Drainage. — The  character  of  the 
plumbing  and  drainage  of  urban  houses  has  a  direct  in- 
fluence upon  the  health  of  the  occupants.  All  the 
appliances,  such  as  sinks,  water-closets,  and  bath-tubs, 
should  be  supplied  with  appropriate  traps,  in  order  to 
exclude  the  drain-air.  These  traps  are  now  generally 
required  by  the  sanitary  laws  of  all  large  municipalities, 
and  the  form  and  character  of  the  traps  to  be  employed 
are  frequently  stated  in  these  laws.  While  the  danger 
from  sewer-air  spoken  of  in  the  older  text-books  is  greatly 
exaggerated,  it  is  well  known  that  such  air  must  be 
rigidly  excluded  from  houses  to  avoid  any  possible  in- 
jurious effects.  Continued  breathing  of  air  containing 
the  considerable  quantities  of  carbon  dioxid  found  in 
sewer-air,  besides  the  other  putrefactive  gases  present  in 
it,  will  eventually  prove  injurious. 

The  plumbing  should  serve  to  bring  into  the  house  an 
abundant  supply  of  water  and  distribute  it  to  all  parts  for 
convenient  use.  The  drainage  system  should  be  so  con- 
structed as  to  remove  promptly  and  safely  all  sewage  and 
waste  water  from  the  house. 

Houses  for  the  Poor. — The  overcrowded  condition 
and  unhealthful  character  of  the  habitations  of  the  poor 
have  called  forth  special  regulations  governing  this  mat- 
ter in  many  large  cities.  The  causes  which  have  led  to 
overcrowding  are  numerous,  the  principal  being  (i)  the 
necessity  of  living  near  their  work,  (2)  the  high  price 
of  land  arising  from  the  same  fact,  (3)  the  higher  taxes 
and  rents  resulting  from  the  same  conditions,  and  (4) 
limited  means,  which  prevent  them  from  living  under 
better  conditions. 


HOUSES  FOR  THE  POOR.  329 

In  recent  years  this  condition  of  overcrowding  has 
been  greatly  diminished  through  the  influence  of  several 
factors,  such  as  (1)  the  employment  of  electricity  as  a 
motive  power  for  street  railways.  By  this  means  the 
cost  of  travelling  has  been  diminished,  the  speed  of  the 
cars  has  been  increased,  and  the  lines  of  travel  have  been 
extended  into  the  suburbs  of  cities,  where  cheaper  and 
more  healthful  houses  can  be  procured.  (2)  The  destruc- 
tion by  the  municipal  authorities  of  the  more  objection- 
able of  the  overcrowded  tenements.  (3)  The  regulation 
of  the  size,  construction,  and  arrangement  of  all  new 
dwellings  by  means  of  legislation.  One  of  the  most 
efficient  means  of  preventing  overcrowding  is  to  be 
sought  in  affording  better  communication  between  the 
periphery  and  center  of  a  city,  so  that  those  working  in 
the  city  are  not  compelled  to  live  there,  but  make  it  pos- 
sible for  them  to  live  in  the  suburbs. 

According  to  the  investigations  of  J.  Bertillon,1  the 
population  of  Paris  is  distributed  in  the  following  man- 
ner :  149  per  1000  live  in  overcrowded  dwellings,  363  per 
1000  have  insufficient  room,  266  per  1000  have  sufficient 
room,  and  the  remainder  have  more  than  sufficient  room. 

According  to  the  same  authority,  the  proportion  of 
population  living  in  overcrowded  dwellings  in  the  larger 
European  cities  is  as  follows  : 

280  per  1000  of  the  Berlin  population. 
200       "             "       London  " 

310       "  "       Moskow  " 

460        "  "       St.  Petersburg  " 

740       "  "       Budapest  " 

Of  the  Paris  population,  378  per  1000  have  2  persons 
per  family,  687  per  1000  have  4  persons  per  family,  753 
per  1000  have  7  persons  per  family,  and  295,000  out  of 
947,000  families  consist  of  only  1  person  ;  and  369,000 
out  of  942,000  dwellings  have  1  room. 

Municipal  legislation  regulating  the   construction  of 

1  Rev.  d' Hyg.,  vol.  xxi.,  p.  588. 


330  HABITA  TIONS. 

workingmen's  homes  should  prescribe  the  size  of  the 
rooms,  the  number  of  square  meters  of  floor  space  for 
each  occupant,  and  the  amount  of  window  surface  in  re- 
lation to  the  floor  surface.  The  regulations  should  also 
direct  the  character  of  the  drainage  facilities  that  are  to 
be  supplied. 

In  many  European  cities  the  construction  of  new  houses 
is  so  regulated  as  to  prohibit  the  utilization  of  more  than 
a  definite  proportion  of  the  ground  surface  for  building 
purposes.  This  feature  prevents  the  construction  of 
houses  in  toe  close  proximity  to  adjoining  houses.  In 
many  of  these  regulations  the  height  of  the  houses  is 
regulated  by  the  width  of  the  streets  on  which  they  front, 
or  the  section  of  the  city  in  which  they  are  located.  For 
instance,  in  Bonn,  a  city  with  50,000  inhabitants,  the 
smallest  size  of  the  yards  in  the  business  section  is  25  per 
cent,  of  the  ground  surface  for  buildings  one  storv  in 
height,  and  35  per  cent,  for  buildings  more  than  one 
story  in  height,  and  the  greatest  height  allowed  is  20 
meters.  In  the  residence  portion  of  the  city  the  smallest 
size  of  the  yards  is  25  per  cent,  for  houses  of  one  story  in 
height,  and  50  per  cent,  for  houses  of  more  than  one 
story  in  height,  and  the  greatest  height  allowed  is  17 
meters. 

Building  regulations  should  also  include  the  require- 
ments of  lodging-  and  boarding-houses,  because  it  is  in 
these  that  a  great  degree  of  overcrowding  is  found.  These 
regulations  should  state  the  amount  of  cubic  space  that 
must  be  allowed  for  each  lodger,  according  to  age,  and 
the  arrangements  for  the  efficient  ventilation  of  the  rooms 
that  are  necessary  to  secure  a  continuous  supply  of  pure 
air.  These  regulations  should  also  provide  for  the  gen- 
eral sanitary  supervision  of  the  premises  and  arrange- 
ments by  competent  inspectors. 

House-cleaning. — From  the  fact  that  living  bacteria 
may  be  contained  in  the  dust  of  rooms  the  method  of 
house  cleaning  is  of  importance.  Great  care  should  be 
exercised    to    avoid    disturbing   collections   of    dust    on 


PROTECTION  FROM  FLIES  AND  MOSQUITOES.  331 

horizontal  surfaces.  All  the  furniture,  woodwork,  and 
painted  walls  should  be  wiped  carefully  with  a  dampened 
cloth,  in  order  to  remove  the  dust  without  causing  it  to 
rise  into  the  air  of  the  room. 

The  rugs  on  the  floor  should  be  removed  from  time  to 
time  and  thoroughly  dried  and  cleaned.  The  floors 
should  be  waxed  and  polished  before  replacing  the  rugs. 
Special  preparations  have  been  perfected  for  this  purpose. 
These  are  applied  by  means  of  a  long-handled  brush  and 
then  rubbed  into  the  floor  by  means  of  a  large  burnisher. 
Some  of  these  floor  preparations  contain  turpentine,  or 
other  antiseptic  substances,  and  serve  a  useful  purpose  in 
addition  to  preserving  the  quality  of  the  floor. 

Protection  from  Flies  and  Mosquitoes. — Since  flies 
are  frequent  carriers  of  disease,  they  should  be  rigidly 
excluded  from  the  house.  Flies  light  on  all  kinds  of 
filth,  and  in  this  manner  their  bodies  become  infected 
with  pathogenic  bacteria,  and  they  no  doubt  carry  these 
bacteria  from  place  to  place  and  contaminate  whatever 
they  light  upon.  During  the  Spanish-American  War 
the  spreading  of  typhoid  fever  from  one  camp  to  another 
was  probably  in  part  due  to  this  mode  of  dissemination 
of  the  typhoid  bacillus.  During  the  summer  months, 
therefore,  all  the  doors  and  windows  should  be  fitted  with 
efficient  mosquito-bars,  in  order  to  exclude  flies  and 
mosquitoes.  The  experiences  of  the  several  commissions 
which  have  been  sent  to  malarious  localities  in  Africa, 
Italy,  and  India  have  demonstrated  the  fact  that  simply 
excluding  mosquitoes  from  habitations  by  means  of 
mosquito-bars  served  to  protect  the  occupants  against 
malarial  infection. 


CHAPTER   XVII. 
VITAL  CAUSES  OF  DISEASE. 

The  vital  causes  of  disease  are  those  vegetable  and 
animal  organisms  which  are  capable  of  existing  as  para- 
sites in  or  upon  the  human  host,  and  by  their  mere 
presence,  or  through  the  production  of  poisonous  prod- 
ucts, cause  disease.  The  vegetable  organisms  producing 
disease  are  of  two  classes — the  bacteria,  and  various 
fungi  which  produce  local  affections  of  the  skin.  Fortu- 
nately, only  a  small  proportion  of  the  bacteria  found  in 
nature  are  pathogenic.  A  number  of  the  specific  dis- 
eases, however,  have  been  traced  to  the  activity  of  these 
organisms.  All  of  these  pathogenic  organisms  are  trans- 
missible from  one  individual  to  another  if  not  already 
immune.  One  attack  of  certain  of  these  specific  dis- 
eases confers  immunity  against  subsequent  infection  from 
the  same  species  of  organism.  In  some  instances  this 
immunity  is  permanent,  lasting  throughout  life,  while  in 
other  diseases  it  is  of  short  duration,  lasting  only  a  few 
weeks  or  months.  The  specific  organisms  of  each  dis- 
ease differ  in  their  morphologic  and  biologic  characters 
from  those  causing  other  diseases  to  such  an  extent  that 
they  can  be  recognized  and  isolated. 

The  bacteria  which  are  pathogenic  for  man,  and  the 
specific  organisms  of  the  following  diseases,  belong  to 
the  vegetable  kingdom,  and  have  been  discovered  and 
isolated  as  follows: 

1839,  parasite  of  favus; 

1863,  bacillus  of  anthrax — Davaine; 

1873,  spirillum  of  relapsing  fever — Obermeier; 

1875,  bacillus  of  malignant  edema — Pasteur; 

1878,  actinomycosis — Bollinger; 

332 


VITAL  CAUSES  OF  DISEASE. 


333 


1879 
1880 
1880 
1881 
1882 
1882 
1882 
1882 
1883 
1883 
1884 
1884 
1884 
1884 
1885 
1885 
1886 
1886 
1887 


selbaum; 


1889 
1892 
1894 
1894 

Weeks 

1895 
1897 


micrococcus  of  gonorrhea — Neisser; 
micrococcus  lanceolatus  (pneumonia) — Sternberg ; 
bacillus  of  typhoid  fever — Eberth; 
micrococcus  tetragenus — Koch  and  Gaffky; 
bacillus  pyocyaneus — Gessard; 
bacillus  of  tuberculosis — Koch; 
bacillus  of  glanders — Loffler  and  Schiitz; 
bacillus  of  rhinoscleroma — von  Fisch; 
streptococcus  pyogenes — Fehleisen ; 
bacillus  lanceolatus — Friedlander  and  Frobenius; 
vibrio  of  Asiatic  cholera — Koch ; 
staphylococcus  aureus  and  albus — Rosenbach; 
bacillus  of  diphtheria — Klebs  and  Loffler; 
bacillus  of  tetanus — Nicolaier; 
staphylococcus  citreus — Passet; 
bacillus  proteus  vulgaris — Hauser; 
bacillus  coli  communis — Escherich; 
bacillus  lactis  aerogenes — Escherich; 
micrococcus  intracellularis  meningitidis — Weich- 


bacillus  capsulatus — Pfeiffer; 

bacillus  of  influenza — Pfeiffer; 

bacillus  of  bubonic  plague — Yersin  and  Kitasato; 

bacillus    of    infectious     conjunctivitis  —  Koch- 


bacillus  botulinus — Van  Ermengfen: 
bacillus    enteritidis   sporogenes — Klein;    micro- 
coccus melitensis; 

1900,  bacillus  mortiferus — Harris. 

In  the  following  diseases  no  specific  organisms  have  as 
yet  been  isolated,  though  from  their  clinical  manifesta- 
tions and  contagious  character  they  are  believed  to  be 
due  to  some  specific  agent:  Small-pox,  varicella,  measles, 
scarlet  fever,  whooping-cough,  mumps,  dengue,  typhus 
fever,  yellow  fever,  rabies,  and  rheumatism.  A  variety 
of  micro-organisms  has  been  found  in  most  of  these 
diseases,  though  none  of  them  has  been  positively  de- 
monstrated as  specific. 


334  VITAL  CAUSES  OF  DISEASE. 

Modes  of  Dissemination. — Those  diseases  which  are 
infectious  may  be  disseminated  in  several  different  ways. 
The  confusion  which  is  more  or  less  prevalent  with 
regard  to  the  exact  term  to  employ  in  each  disease, 
whether  infectious  or  contagious,  has  led  numerous 
writers  to  abandon  one  or  the  other  term.  Since  all  con- 
tagious diseases  are  infectious,  it  seems  preferable  to 
abandon  both,  and  to  substitute  the  term  transmissible, 
as  has  been  done  by  Dr.  Abbott,1  and  call  those  diseases 
which  were  formerly  designated  as  contagious,  trans- 
missible by  direct  contact,  and  those  diseases  which  were 
formerly  designated  as  infectious,  transmissible  by  indi- 
rect contact.  Diseases  like  small-pox,  measles,  and  scar- 
let fever  are  transmissible  by  direct  contact;  and  diseases 
like  typhoid  fever  are  usually  transmissible  by  indirect 
contact. 

Some  of  the  diseases,  however,  which  are  frequently 
disseminated  by  direct  contact  may,  and  often  are,  dis- 
seminated indirectly  through  the  medium  of  food  infected 
with  the  specific  micro-organisms,  or  through  the  agency 
of  flies  or  other  insects  whose  bodies  have  become  infected 
by  coming  in  contact  with  infective  materials.  A  num- 
ber of  diseases,  prominent  among  which  are  those  due  to 
animal  parasites,  are  disseminated  through  the  use  of 
meat  derived  from  infectious  animals,  through  water  pol- 
luted with  animal  excrement,  or  through  green  vege- 
tables that  have  come  in  contact  with  such  excrement. 

In  addition  to  diseases  transmitted  by  these  modes  of 
dissemination,  there  are  some  diseases  in  which  the 
infective  agent  passes  one  of  its  cycles  in  the  body  of  an 
insect,  and  is  disseminated  through  the  bite  of  such 
infected  insect.  The  disease  which  is  best  known  as 
being  disseminated  in  this  manner  is  malaria,  which  is 
disseminated  through  the  bite  of  infected  anopheles, 
while  filariasis  is  believed  to  be  disseminated  through  the 
bite  of  another  mosquito,  a  species  of  culex,  and  the 
latest  studies  upon  yellow  fever  indicate  most  strongly 

1  The  Hygiene  of  Transmissible  Diseases. 


NATURE  OF  EPIDEMICS.  335 

that  this  disease  is  disseminated  through  the  bite  of 
another  variety  of  the  genus  culex. 

In  the  light  of  the  discoveries  in  regard  to  the  mode  of 
dissemination  of  malaria,  filariasis,  and  yellow  fever  by 
means  of  mosquitoes,  and  the  dissemination  of  Texas  cat- 
tle fever  by  means  of  the  cattle  tick,  it  is  safe  to  predict 
that  other  diseases  will  be  found  to  be  disseminated  by 
somewhat  similar  agencies.  There  is  no  doubt  that  in  the 
immediate  future  the  investigations  of  scientists  will  be 
directed  toward  the  discovery  of  such  disseminating 
agencies,  and  with  the  discover}'  of  such  agencies  the 
causes  of  these  diseases,  as  yet  undetermined,  may  like- 
wise be  discovered,  and  our  measures  of  prevention  placed 
upon  a  more  satisfactory  basis. 

Nature  of  Epidemics. — The  opinions  of  authorities 
differ  with  regard  to  the  number  of  cases  of  any  infectious 
disease  that  may  exist  in  a  community  before  the  disease 
may  be  declared  to  be  epidemic  in  its  character.  A  few 
isolated  cases  are  usually  spoken  of  as  an  "outbreak" 
of  the  disease;  but  when  the  number  of  cases  amounts  to 
i  per  iooo  of  the  population,  it  is  usually  said  to  be 
epidemic.  In  England,  measles  is  said  to  be  epidemic 
when  the  number  of  cases  amounts  to  1.2  per  1000  of  the 
population.  In  olden  times  yellow  fever  was  said  to  be 
epidemic  when  the  number  of  deaths  from  that  disease 
exceeded  the  number  from  all  other  causes.  At  the 
present  time  the  disease  is  considered  epidemic  in  New 
Orleans  when  there  are  between  2000  and  5000  cases,  or 
about  22  per  1000  of  population.  Usually  when  10  cases 
of  any  disease  develop  in  close  proximity  to  each  other, 
when  all  sanitary  precautions  have  been  exercised,  the 
disease  is  said  to  be  epidemic. 

A  disease  is  said  to  be  epidemic  when  the  infection  has 
been  imported  into  a  locality  and  spreads  over  an  area. 
A  disease  is  said  to  be  endemic  when  it  develops  within  a 
locality,  or  is  peculiar  to  a  locality,  and  spreads  over  an 
area.  A  disease  is  said  to  be  pandemic  when  it  spreads 
over  very  large  areas  or  prevails  in  several  continents  at 


336  VITAL  CA  USES  OF  DISEASE. 

the  same  time.  The  term  pandemic  disease  is  usually 
applied  to  cholera,  yellow  fever,  influenza,  and  plague. 
The  different  pandemic  diseases  have  local  habitats  from 
which  they  are  rarely  or  never  absent.  The  habitat  of 
influenza  is  in  Russia,  that  of  cholera  in  the  valley  of 
the  Ganges  River,  that  of  plague  in  Indo-China,  and  that 
of  yellow  fever  in  Cuba. 

Immunity  and  Susceptibility. — When  we  undertake 
to  investigate  the  causative  factors  underlying  the  results 
of  the  exposure  of  an  entire  community  to  a  source  of 
infection,  with  the  idea  of  ascertaining  the  reasons  why 
a  certain  proportion  of  such  a  community  escapes  the 
infection,  a  number  of  questions  of  great  practical  im- 
portance present  themselves.  We  are  frequently  satis- 
fied in  solving  these  questions  by  saying  that  those  mem- 
bers of  the  community  which  escaped  the  disease  did  so 
from  the  fact  that  they  were  not  susceptible,  or,  probably, 
that  they  were  immune,  and  that  those  who  contracted 
the  disease  were  susceptible,  or  that  they  were  not  im- 
mune. 

It  will  be  necessary  to  consider  briefly  what  is  meant 
by  the  terms  susceptibility  and  immunity,  and  then  we 
shall  better  understand  why  such  differences  in  effects 
manifest  themselves. 

Immunity  may  be  described  as  that  condition  of  the 
body  in  which  the  organism  resists  the  invasion  of  dis- 
ease-producing bacteria,  or  resists  their  growth  and 
activity  after  they  have  gained  an  entrance;  while  sus- 
ceptibility is  the  opposite  condition,  in  which,  instead  of 
resistance,  there  is  a  passive  inertia,  which  allows  the 
disease-producing  bacteria  to  develop. 

Immunity  is  either  natural  or  acquired.  Natural  im- 
munity is  the  inherent,  vital,  reactive  state  of  a  healthy 
organism  against  the  invasion  of  foreign  agents.  This 
natural  resistance  to  the  invasion  of  disease-producing 
bacteria  is  to  some  extent  a  racial  condition,  as  seen  in 
the  greater  susceptibility  of  some  races  to  certain  dis- 
eases than  others.     It  is  also  to  some  extent  a  family 


IMMUNITY  AND  SUSCEPTIBILITY.  337 

condition  transmitted  from  generation  to  generation. 
Again,  it  may  be  simply  an  individual  condition.  All 
of  these  forms  of  immunity  are  frequently  observed  in 
the  human  family  as  well  as  in  the  lower  animals  com- 
monly employed  in  investigations  with  disease-producing 
bacteria.  This  natural  immunity,  in  man  as  well  as  in 
animals,  is  frequently  destroyed  through  external  agen- 
cies, such  as  changes  in  the  nature  and  quantity  of  the 
food-supply,  changes  of  modes  of  living,  as  from  outdoor 
occupations  to  indoor  occupations,  undue  exposure,  close 
confinement  through  lack  of  sunshine  and  fresh  air,  as 
well  as  many  other  changes  in  the  environment  which 
tend  to  lower  the  general  vitality  of  the  system.  By 
modifications  in  the  activity  and  environment  of  the 
lower  animals  it  is  often  possible  to  render  them  suscep- 
tible to  the  action  of  certain  bacteria  which  do  not  affect 
them  normally. 

Acquired  immunity  may  be  divided  into  four  classes: 
(1)  That  induced  by  recovery  from  a  previous  attack  of 
a  disease,  as  is  the  case  with  some  of  the  common  dis- 
eases of  children,  as  rubeola,  scarlatina,  and  varicella. 
One  attack  of  these  diseases  usually  confers  immunity 
for  life.  (2)  That  induced  by  an  attack  of  an  allied  dis- 
ease, as  in  the  immunity  conferred  by  vaccinia  against 
variola.  (3)  That  induced  by  the  injection  of  antitoxic 
substances,  as  in  diphtheria.  (4)  That  induced  by  the 
injection  of  toxins,  as  in  the  protection  against  typhoid 
fever  and  plague  by  means  of  filtered  bouillon  cultures 
of  the  specific  organisms  of  these  diseases.  It  has  been 
demonstrated  over  and  over  again  in  epidemics  of  diph- 
theria that  the  injection  of  small  doses  of  antitoxin  into 
children  exposed  to  infection  serves  to  break  up  the  epi- 
demic. This  form  of  immunity  is,  however,  of  short 
duration,  lasting  only  from  one  to  two  months.  The 
first  two  forms  of  acquired  immunity  are  generally 
designated  as  active  immunity,  while  that  conferred  by 
means  of  antitoxin  and  toxin  is  designated  as  passive 
immunity  because  of  its  short  duration. 
22 


338  VITAL  CA  USES  OF  DISEASE. 

With  equal  propriety  we  may  speak  of  susceptibility 
as  being  either  natural  or  acquired.  Susceptibility  may 
be  said  to  have  been  acquired  when  disease  is  contracted 
because  of  the  lowered  tone  of  the  organism  through  the 
influence  of  the  many  factors  which  tend  to  destroy  nat- 
ural immunity.  We  frequently  see  instances  in  which 
the  degree  of  susceptibility  has  been  increased  through 
the  many  influences  which  may  operate  so  as  to  lower 
the  tone  of  the  organism.  This  is  especially  the  case  in 
children  when  an  attack  of  some  acute  infectious  disease 
follows  before  convalescence  from  some  other  disease  has 
been  completed. 

A  number  of  theories  have  been  proposed  to  explain 
the  phenomena  of  acquired  immunity,  but  some  of  the 
earlier  ones  have  been  found  to  be  erroneous  and  are  no 
longer  tenable.  A  few  of  the  more  important  of  these 
may  be  briefly  stated  before  taking  up  those  which  are 
held  at  the  present  day.  The  first  is  the  "exhaustion  " 
theory  proposed  by  Pasteur  in  1880,  which  assumed  that 
through  the  growth  of  the  bacteria  in  the  organism  they 
destroyed  some  substance  essential  to  their  life  and  so 
made  subsequent  growth  of  the  same  species  of  bacteria 
impossible  in  such  an  organism,  the  complete  destruction 
of  this  substance  in  an  organism  conferring  complete 
immunity.  Another  theory  known  as  the  "retention" 
theory  was  proposed  by  Chauveau  about  the  same  time, 
which  assumed  that  some  product  of  the  vital  activity  of 
the  bacteria  was  retained  in  the  organism  which  was 
prejudicial  to  the  subsequent  development  of  the  same 
species.  Both  of  these  theories  have  now  been  discarded 
as  affording  no  satisfactory  explanation  of  acquired  im- 
munity. Besides  these,  three  other  theories  have  been 
proposed,  which,  while  presenting  considerable  evidence 
in  explanation  of  the  phenomenon,  have  failed  of  general 
adoption  because  they  fail  to  meet  all  the  conditions. 
The  first  of  these  theories  is  that  of  "phagocytosis," 
propounded  by  Metschnikoff  in  1884.  He  had  demon- 
strated that  certain  cells  of  the   body — the  connective- 


IMMUNITY  AND  SUSCEPTIBILITY.  339 

tissue  cells  and  the  leukocytes — had  the  power  of  absorb- 
ing living  bacteria  from  the  fluids  and  tissues  of  the  body. 
This  fact  can  be  very  readily  demonstrated  experimentally 
by  inoculating  certain  bacteria  into  animals.  The  pres- 
ence in  the  blood  of  enormous  numbers  of  leukocytes  at 
certain  stages  of  many  bacterial  diseases  is  likewise  a 
strong  indication  that  they  have  important  functions  to 
perform  in  these  diseases.  According  to  this  theory,  the 
extent  of  the  affinity  of  the  leukocytes  for  the  bacteria  is 
directly  dependent  upon  the  degree  of  immunity.  After 
taking  up  the  bacteria  the  leukocytes  are  carried  in  the 
blood-current  to  the  large  glandular  organs,  the  liver  and 
spleen,  where  they  are  probably  destroyed  along  with 
their  contained  bacteria,  or,  in  the  case  of  wounds,  they 
are  cast  off  as  pus  with  the  other  debris  resulting  from 
the  disease-process. 

Another  theory  proposed  to  explain  immunity  is  known 
as  the  "humoral"  theory,  and  has  been  advanced  by 
Buchner.  It  is  well  known  that  the  serum  of  normal 
blood  has  the  power,  to  a  considerable  extent,  of  destroy- 
ing bacteria,  and  on  this  fact  Buchner  based  his  theory 
that  the  pathogenic  bacteria  are  destroyed  within  the 
body  by  the  bactericidal  action  of  the  blood-plasma,  and 
not  by  the  leukocytes.  Many  of  the  normal  fluids  of  the 
body  also  possess  this  bactericidal  action  to  a  certain 
extent.  Buchner  has  applied  the  term  alexins  to  the 
bactericidal  proteid  substances  of  the  blood. 

The  theory  of  immunity  which  remains  to  be  consid- 
ered has  been  offered  in  explanation  of  acquired  im- 
munity. This  is  the  theory  of  the  antitoxins.  This 
theory  is  based  on  the  fact  that  individuals  can,  by 
gradual  dosage,  acquire  a  certain  tolerance  to  powerful 
drugs,  as  opium  and  tobacco,  and  that  animals  can  be 
brought  to  tolerate,  without  apparent  detrimental  effect, 
enormous  doses  of  the  highly  poisonous  products  of  bac- 
teria. It  has  been  found  that  the  blood  of  persons  accus- 
tomed to  the  use  of  poisonous  drugs,  as  well  as  the  blood 
of  animals  tolerant   to    bacterial    toxins,    is   capable  of 


340  VITAL  CAUSES  OF  DISEASE. 

conferring  a  similar  tolerance  in  animals  when  injected 
into  their  bodies.  The  albuminoid  principles  contained 
in  such  blood,  and  which  are  capable  of  conferring  toler- 
ance of  this  kind,  have  been  called  antitoxins.  These 
antitoxins  are  neutralizing  agents,  and  act  by  neutralizing 
the  poisonous  substances  against  which  they  act.  They 
are  formed  within  the  body  as  the  result  of  the  vital 
activities  of  the  fluids  and  cells  of  the  body. 

A  very  interesting  theory  as  to  the  mode  of  formation 
of  these  antitoxins  has  recently  been  proposed  by 
Ehrlich,  who  assumes  that  they  are  formed  as' the  result 
of  a  chemical  union  between  the  toxins  and  some  sub- 
stance normally  present  in  the  body  in  a  manner  similar 
to  the  union  taking  place  when  an  acid  and  a  base  are 
brought  together,  resulting  in  the  formation  of  a  salt. 
This  is  Ehrlich' s  "side-chain"  theory.  In  a  recent 
paper  on  testing  the  value  of  diphtheria-antitoxin 
Bhrlich  assumes  that  in  the  poisoning  of  an  animal  with 
tetanus-toxin,  for  instance,  it  is  necessary  that  certain 
cells  (in  tetanus  the  cells  of  the  central  nervous  system) 
form  a  combination  with  the  toxin.  He  calls  the  part  of 
the  cell  which  combines  with  the  toxin  the  "  toxophore  " 
side-chain.  He  believes  that  the  antitoxin  is  nothing 
else  than  these  side-chains  which  have  been  cast  off  from 
the  cells,  the  cells  being  again  regenerated,  in  the  pro- 
cess of  immunization,  the  antitoxin  in  tetanus  consisting- 
of  portions  of  the  cells  of  the  central  nervous  system  that 
have  united  with  the  toxin  and  passed  into  solution.  In 
other  words,  he  believes  that  the  cells  of  the  central 
nervous  system,  having  a  selective  affinity  for  the  tetanus- 
toxin,  unite  with  it  in  such  a  manner  that  one  of  the 
groups  of  elements  composing  the  complex  albuminoid 
substance  of  these  cells  enters  into  intimate  chemical 
union  with  the  toxin  to  form  a  new  bod}- — the  antitoxin 
— which  flows  in  the  blood-current. 

Wassermann1  assumed  that  if  this  theory  of  Ehrlich 
was    correct,   it  would   be   possible    to    demonstrate    the 

1  Berline?-  klinische  Wochenschrift,  1898,  p.  4. 


IMMUNITY  AND  SUSCEPTIBILITY.  341 

presence  of  such  antitoxic  principles  preformed  in  the 
cells  of  the  central  nervous  system  which  would  protect 
against  tetanus.  He  took  the  spinal  cord  and  brain  of 
normal  animals  and  ground  them  up  with  physiological 
salt-solution,  mixed  the  emulsion  with  tetanus-toxin  and 
injected  it  into  white  mice,  which  are  very  susceptible 
to  tetanus-toxin.  He  found  that  the  spinal  cord,  and 
especially  the  brain,  of  all  the  animal  species  so  far 
tested,  as  man,  guinea-pigs,  rabbits,  pigeons,  and  horses, 
showed  antitoxic  action,  while  no  other  organ  of  the 
body  possessed  such  an  action.  He  found  that  the  nor- 
mal central  nervous  system  has  not  only  this  neutralizing 
power  against  the  tetanus-toxin,  but  that  it  afforded  pro- 
tection when  injected  twenty-four  hours  previously,  and 
even  when  injected  some  hours  after  the  tetanus-toxin 
had  been  administered. 

Wassermann  believes  that  the  side-chain  theory  of  im- 
munity rests  upon  certain  normal  substances  of  the  body 
which  have  a  specific  affinity  for  the  toxin,  and  that  the 
mode  of  protection  against  toxins  after  injection  of  the 
brain-emulsion  is  due  to  the  fact  that  the  affinity  of  these 
substances  causes  them  to  unite  with  the  toxin  circu- 
lating in  the  blood,  and  thus  protect  the  body-cells  from 
harm.  He  believes  further  that  the  antitoxic  substances 
present  in  the  normal  central  nervous  system  are  identi- 
cal with  those  found  in  the  serum  in  artificial  immunity. 

With  Takaki,1  Wassermann  sought  to  ascertain  whether 
the  antiseptic  power  of  the  central  nervous  system  could 
be  traced  to  a  substance  which  was  soluble  in  water,  or 
whether  the  power  resided  in  the  cells  themselves  ;  he 
reaches  the  conclusion  that  the  latter  is  the  case,  as  indi- 
cated in  Ehrlich's  theory.  The  clear  filtrate  of  the  cen- 
trifugalized  brain-emulsion  had  practically  no  antitoxic 
action,  while  the  cell-emulsion  had  this  action.  Neither 
did  the  fluid  of  the  ventricles  of  the  brain  possess  any  action. 

Roux  and  Borrel2  point  out  the  interesting  fact  that 
the  rat  is  not  affected  by  large  doses  of  diphtheria-toxin 

1  Loc.  cit.,  p.  5-  "  Annates  de  Plnstitut  Pasteur,  April,  1S98,  p.  225. 


342  J  I  TAL  CA  USES  OF  DISEASE. 

when  administered  subcutaneously,  but  when  injected 
into  the  brain  the  rat  becomes  paralyzed,  indicating  that 
the  destruction  of  the  diphtheria-toxin  in  the  rat  is 
brought  about  by  the  cells  of  the  body  other  than  those 
of  the  central  nervous  system. 

Of  like  interest  is  the  effect  of  morphin  upon  rabbits. 
Roux  and  Borrel  state  that  a  rabbit  of  2  kilos  in  weight 
can  readily  withstand  a  dose  of  30  centigrams  of  mor- 
phin when  injected  hypodermically,  but  when  injected 
into  the  brain  a  dose  of  1  milligram  produces  paralysis 
and  stupor,  lasting  for  twenty-four  to  thirty  hours,  and 
the  animal  dies  in  four  or  five  days.  The  cells  of  the 
central  nervous  system  are  quite  sensible  to  the  morphin, 
but  when  injected  hypodermically  it  never  reaches  the 
cerebral  cells,  but  is  destroyed  in  the  body  by  certain 
cells  which  perform  the  role  of  protective  agents  and 
probably  manufacture  the  antitoxins. 

Bardach  *  reports  an  interesting  series  of  experiments 
which  indicate  that  the  spleen  performs  an  important 
function  in  overcoming  anthrax  infection.  He  removed 
the  spleens  of  numbers  of  dogs,  and  found  that  19  out  of 
25  died  from  anthrax  infection,  while  only  5  out  of  25 
control-dogs  died.  Likewise,  of  35  extirpated  rabbits  26 
died,  and  of  the  control-animals  not  one  died. 

The  experiments  of  Bardach  are  of  especial  interest 
when  considered  in  connection  with  those  of  Blumreich 
and  Jacoby,2  who  experimented  upon  extirpated  animals 
with  several  other  bacteria  and  their  toxins,  and  found 
that,  with  the  exception  of  anthrax-bacilli,  the  extirpated 
animals  injected  with  the  bacteria  or  their  toxins,  showed 
even  greater  resistance  than  normal  animals.  All  of 
these  experiments  seem  to  strengthen  the  opinion  that 
the  antitoxic  principles  of  different  diseases  are  elabo- 
rated by  different  cells  of  the  organs  of  the  body. 

The  work  of  Emmerich  and  Loew3  with  regard  to  the 

1  Annates  de  F Institut  Pasteur,  1S89  and  1 89 1. 

2  Zeit.  f.  Hyg.,  Bd.  xxix.,  p.  419. 

3  Ibid.,  Bd.  xxxvi. 


IMMUNITY  AND  SUSCEPTIBILITY.  343 

immunizing  substance  contained  in  cultures  of  bacillus 
pyocyaneus  and  other  organisms,  and  the  artificial  prep- 
aration of  antitoxic  substances  by  means  of  a  combina- 
tion of  such  immunizing  substance  with  proteid  material 
derived  from  the  blood  or  organ  fluids,  has  elicited  a 
great  deal  of  interest.  They  have  shown  that  the 
immunizing  substance  contained  in  cultures  is  of  the 
nature  of  an  enzyme.  These  enzymes  they  have  desig- 
nated nucleases.  They  found  that  most  nucleases  are 
conform  in  character  in  that  they  dissolve  only  those 
bacteria  producing  them,  while  several  nucleases,  as  that 
of  bacillus  pyocyaneus,  are  heteroform  in  character  in 
that  they  dissolve  other  organisms  as  well.  The  pyocy- 
aneus proteolytic  enzyme,  when  combined  with  blood- 
serum — pyocyaneus-immune  proteid — is  capable  not  only 
of  dissolving  the  diphtheria  bacillus  in  human  or  animal 
bodies,  but  also  of  neutralizing  the  effect  of  the  diph- 
theric toxin.  It  has  a  similar  action  upon  anthrax, 
typhoid  fever,   and  plague. 

Emmerich  and  Loew  state  that  artificial  immunity 
against  infectious  diseases  rests  upon  the  formation  of 
conform  nucleases  in  the  organism  and  the  combination 
of  these  with  the  body  albumin  under  the  influence  of 
the  alkalinity  of  the  blood.  / 

The  recent  work  of  Ehrlich  and  Morgenroth  1  throws 
additional  light  upon  the  mechanism  of  immunity. 
They  show  that  in  the  immunization  of  an  animal  two 
substances  are  brought  into  action  in  the  immunizing 
process,  the  so-called  immune  body,  or  receptor,  derived 
from  the  micro-organisms,  and  the  complement  which 
exists  in  the  animal  body.  Through  the  combined 
action  of  these  two  substances  the  bacteria  and  their 
toxins  are  destroyed. 

Our  knowledge  of  natural  and  artificial  immunity  has 
been  summarized  by  Wassermann2  as  follows: 

(1)  "  The  complements  pre-exist  in  the  body.  (2)  The 
complements   play  a  causative  role  in  certain  forms  of 

1  Berlin,  klin.  Woch.,  1901.  2  Zeit.  f.  Hyg.,  Bd.  xxxvii.,  S.  173. 


344  .    VITAL  CAUSES  OF  DISEASE. 

natural  resistance  to  infection.  (3)  The  complements 
are,  however,  not  the  only  cause  for  such  natural  resist- 
ance. (4)  For  certain  forms  of  inherited  immunity 
present  methods  are  incapable  of  demonstrating  that  the 
complements  take  any  part  in  the  process.  (5)  In  typhoid 
infection  in  guinea-pigs  the  complements  have  a  direct 
influence  upon  the  acute,  subacute,  and  chronic  course 
of  the  infection.  (6)  The  action  of  the  specific  bacteri- 
cidal immune  serum  in  the  living  organism  rests  upon 
the  combined  action  of  two  substances,  the  immune  body 
and  the  complement.  (7)  Large  doses  of  the  immune 
body  increase  the  affinity  between  it  and  its  correspond- 
ing complement.  (8)  In  the  action  of  the  specific  anti- 
toxic sera  in  the  living  organism  the  complements  take 
no  part  whatever.  (9)  The  active  immunity  of  guinea- 
pigs  against  typhoid  depends  upon  the  circulation  in  the 
organism  of  the  actively  immune  animal  of  the  specific 
bactericidal  immune  serum,  it  is  therefore  a  hema- 
togenous and  not  a  histogenous  immunity.  (10)  The  arti- 
ficial resistance  against  certain  infections  after  injection 
of  different  non-specific  substances  rests  upon  the  fact 
that  the  complements  flow  toward  the  point  of  injection 
of  the  resistance-destroying  substance.  (11)  The  con- 
tinued increase  of  the  complements  in  the  organism  by 
artificial  means  lias  so  far  not  been  successful.  (12)  The 
complements  are  biologically  not  only  bacteriolytic  and 
cytolytic  substances,  but,  in  general,  albumin-digesting 
ferments.  (13)  The  complements  of  the  serum  are  mul- 
tiple, though  certain  forms  are  similar  in  the  different 
animals  so  far  examined.  (14)  The  leukocytes  are  the 
principal,  though  not  the  only,  source  of  the  comple- 
ments." 

The  process  of  antibody  production,  as  it  proceeds 
according  to  the  side-chain  theory,  is  a  complex  one,  and 
consists  of  a  number  of  phases  (combination,  regenera- 
tion, casting  off)  which  in  part  are  independent  of  each 
other.  A  series  of  circumstances  may  arise  which  can 
inhibit    certain    phases    of    the    process.       Through    the 


IMMUNITY  AND  SUSCEPTIBILITY.  345 

anchoring  of  certain  poisonous  substances  by  the  cell  it 
may  be  so  injured  that  the  antibody  formation  does  not 
take  place  or  only  in  very  small  quantities,  because  the 
regenerative  power  of  the  cell  is  affected.  This  will 
happen  especially  with  highly  toxic  substances  in  case 
the  receptors  of  this  substance  are  attached  to  the  cells 
of  vital  organs,  as  those  of  the  central  nervous  system 
by  the  tetanus  poison. 

A  most  interesting  series  of  experiments  by  MM. 
Beclere,  Chambon,  and  Menard1  upon  vaccine  immunity 
bring  out  some  very  important  facts  with  regard  to  vaccinia 
which  had  long  been  assumed  but  never  definitely  deter- 
mined. Their  results  are  of  immense  practical  interest 
in  connection  with  the  question  of  immunity  in  general. 
They  found  that  the  blood-serum  of  vaccinated  heifers 
had  a  very  speedy  immunizing  power  when  injected  into 
other  animals,  even  more  so  than  the  vaccine  virus  itself. 
They  also  studied  the  sera  of  vaccinated  man,  dog, 
and  monkey,  the  serum  of  a  convalescent  from  variola, 
and  finally  the  serum  of  an  animal  vaccinated  with 
variola.  They  found  all  these  to  agree  in  their  action, 
in  vitrio,  upon  the  vaccine  virus,  an  action  which  they 
have  termed  "antivirulent, "  since  the  vaccine  virus, 
after  having  been  acted  upon  by  a  serum  and  inoculated 
into  an  animal,  does  not  produce  nearly  so  much  local 
reaction.  Vaccination  causes  the  antivirulent  power  of 
the  blood-serum  to  appear  whichever  way  it  is  introduced, 
whether  subepidermic,  subcutaneous,  or  intravenous, 
and  whether  it  is  accompanied  or  not  by  cutaneous 
eruption.  The  serum  of  convalescents  from  variola 
exercises  upon  the  vaccine  virus  an  antivirulent  action 
like  the  serum  of  vaccinated  persons  or  animals.  The  same 
is  true  for  the  serum  of  animals  inoculated  with  variola, 
whichever  the  way  of  introduction  of  the  variola  virus 
into  the  organism,  and  accompanied  or  not  by  the  cuta- 
neous eruption. 

1  Annates  de  F Tnstitut  Pastew;  January  25,  1896,  December  25,  1898,  and 
February  25,  1899. 


346  VITAL  CAUSES  OF  DISEASE. 

The  antivirulent  substance  of  the  serum  of  man  and 
the  other  animals  immunized  against  vaccine  or  variola 
infection  is  of  a  very  stable  composition;  it  offers  a 
strong  resistance  to  light,  heat,  moulds,  and  even  to 
putrefactive  agents;  when  dried,  it  resists  a  tempera- 
ture of  ioo°  C.  for  thirty  minutes  without  losing  its 
activity,  and  it  is  not  completely  destroyed  at  1250  C. ;  it 
passes  through  a  porcelain  filter,  but  not  through  a 
dialyzer;  it  is  precipitated  by  alcohol  with  the  albuminoid 
materials  of  the  serum,  appears  to  be  attached  to  the 
globulin,  and  presents  strong  analogies  to  the  diastases. 

The  antivirulent  properties  conferred  upon  the  blood- 
plasma  by  vaccine  or  variola  infection  appear  after  a 
period  of  incubation  which  varies  in  different  species,  but 
the  duration  is  tolerably  fixed  for  each,  and  does  not 
oscillate  in  the  least  within  narrow  limits.  The  blood 
acquires  the  antivirulent  properties  after  several  days. 
In  vaccinated  heifers  it  is  not  fully  developed  until  nine 
to  thirteen  days,  usually  twelve  days,  after  inoculation. 
The  moment  at  which  the  antivirulent  properties  of  the 
serum  show  themselves  fully  developed  marks  the  period 
when  the  vaccine  virus  loses  its  activity  and  when  im- 
munity really  begins. 

These  observers  found  the  period  of  immunity  follow- 
ing vaccine  or  variola  infection  to  be  of  very  variable 
duration  in  different  species,  and  state  that  it  is  composed 
of  two  successive  phases.  The  first  consists  of  the  period 
when  the  blood  manifests  its  antivirulent  properties,  the 
second  phase  consists  of  the  period  when  the  blood  does 
not  manifest  a  trace  of  antivirulent  power,  while  the  skin 
resists  new  inoculations.  During  the  first  phase  of  the 
period  of  immunity  the  antivirulent  substance  passes 
through  the  placenta  from  the  maternal  to  the  fetal  blood, 
and  this  passage  is  an  essential  condition  of  congenital 
immunity. 

In  the  human  species  when  immunity  persists  for  a 
long  time,  though  the  duration  is  very  variable  in  dif- 
ferent individuals,   one  can  detect  the  presence  of   the 


IMMUNITY  AND  SUSCEPTIBILITY.  347 

antivirulent  substance  more  than  twenty-five  years,  and 
even  more  than  fifty  years,  after  the  vaccine  or  variola 
infection.  In  other  subjects  this  substance  shows  itself 
only  for  a  few  months,  weeks,  or  days  after  vaccination. 

The  authors  believe  that  the  production  of  the  anti- 
virulent  substance  in  the  course  of  vaccine  or  variola 
infection  and  its  appearance  in  the  blood-plasma  constitute 
a  definite  reaction  on  the  part  of  the  organism  intimately 
connected  with  the  arrest  of  the  morbid  process  and  the 
development  of  immunity.  They  found  that  the  blood- 
serum  of  vaccinated  heifers  has  not  only  immunizing 
properties,  but  signally  also  preventive  and  curative  prop- 
erties. 

The  fact  that  so  far  no  single  theory  seems  to  explain 
satisfactorily  the  phenomena  of  natural  and  acquired  im- 
munity is  not  at  all  surprising.  Each  specific  organism 
produces  its  own  peculiar  poison  as  the  result  of  its  meta- 
bolic activities,  and  its  own  particular  lesions  and  symp- 
toms, and  undoubtedly  protects  in  its  own  peculiar 
manner  against  subsequent  attacks.  In  those  diseases 
in  which  antitoxins  are  formed  in  the  body  the  antitoxins 
are  of  a  different  nature  in  each  disease,  and  are  most 
probably  elaborated  by  different  cells  of  the  body. 

It  must  be  borne  in  mind  that  each  of  the  different 
antitoxins  known  is  specific  for  only  one  form  of  poison, 
and  this  must  be  quite  evident  if  Ehrlich's  theory  as  to 
the  mode  of  formation  of  antitoxins  holds  true.  We 
know  that  in  chemistry  we  have  only  one  particular 
compound  formed  when  we  mix  silver  and  hydrochloric 
acid  together,  and  for  the  same  reason  each  particular 
toxin  or  poison  can  lead -to  the  formation  of  only  one 
kind  of  antitoxin,  and  this  antitoxin  can  probably 
neutralize  only  that  particular  kind  of  poison. 

The  antitoxin  which  is  best  known  to-day  and  which 
is  most  successfully  employed  as  a  therapeutic  agent  is 
that  of  diphtheria.  Diphtheria  is  a  distinctly  toxic  dis- 
ease ;  the  symptoms  and  lesions,  except  those  at  the  seat 
of  infection,  are  almost  entirely  due  to  the  action  of  the 


348  VITAL  CAUSES  OF  DISEASE. 

toxin  circulating  in  the  blood.  The  fever,  debility,  and 
the  paralysis  occurring  during  convalescence  are  probably 
entirelv  due  to  the  action  of  the  toxin.  The  bacilli  are 
found  in  the  membranous  exudation  forming  upon  the 
fauces,  and  occasionally  in  the  later  stages  of  the  disease 
they  are  found  in  the  lungs  and  the  heart's  blood. 

Antitoxins  are  formed  in  a  number  of  other  diseases, 
and  scientists  have  for  several  years  been  engaged  in  per- 
fecting the  methods  of  commercial  production.  In  some 
diseases  these  attempts  have  proved  successful,  but  in 
many  others  the  results  are  as  yet  not  very  satisfactory. 
The  experiments  of  Marmorek1  indicate  that  his  anti- 
streptococcic serum  is  efficacious  in  the  treatment  of 
erysipelas,  though  in  actual  practice  it  has  not  always 
given  the  results  hoped  for.  It  has,  however,  been  found 
to  be  of  exceptional  value  in  the  treatment  of  tuber- 
culosis accompanied  with  streptococcic  infection.2 

Considerable  work  has  been  done  in  securing  an  anti- 
toxin for  the  treatment  of  typhoid  fever.  This  is  a  dis- 
tinctly toxic  disease,  and  the  blood  of  immune  animals 
yields  an  antitoxin  which  has  been  found  serviceable  in 
the  treatment  of  the  disease.  Recent  reports  made  by 
Lewin  3  and  by  Jez 4  indicate  that  the  efforts  being  made 
to  secure  a  typhoid  antitoxin  are  promising  successful 
results.  The  work  of  Beumer  and  Pfeiffer5  shows  that 
the  blood-serum  of  animals  rendered  immune  against  the 
typhoid  bacillus  possesses  not  only  immunizing  powers, 
but  also  curative  powers,  from  the  fact  that  it  exerted  a 
neutralizing  effect  upon  the  typhoid  toxin. 

The  experiments  of  Yersin,  Borel,  and  Calmette  6  with 
the  bacillus  of  bubonic  plague  show  that  the  blood  of 
immune  animals  contains  an  actively  antitoxic  principle 

1  La  Semaine  med.,  1895,  No.  17,  and  Annates  de  t  Institut  Pasteur,  1S95. 

2  Stubbert,  Trans.  Am.  Climatologicat  Assoc,  189S. 

3  Deutsche  medicinische    Wochenschrift,  January  19.  1899. 

4  Wiener  medicinische  Wochenschrift,  February  18,  1899. 
0  Zeitschrift  filr  ktinische  Medicin,  Bd.  xxviii.  ■ 

6  Aitnates  de  P 'Institut  Pastetir,  1895. 


IMMUNITY  AND  SUSCEPTIBILITY.  349 

which  they  expect  will  prove  serviceable  in  the  treatment 
of  the  disease. 

Experiments  with  the  specific  bacteria  of  pneumonia 
and  of  tuberculosis  also  indicate  that  the  treatment  of 
these  dread  diseases  will  be  simplified  before  many 
years  by  the  perfection  of  efficient  antitoxic  sera.  The 
experience  at  the  Loomis  Sanitarium 1  with  the  anti- 
tubercle-serum,  furnished  by  de  Schweinitz,  of  the  Bio- 
chemical Laboratory  at  Washington,  is  very  encouraging 
for  the  future.  The  percentage  of  improvements  is 
greater  than  with  any  of  the  modern  methods  of  treatment, 
and  they  have  had  no  relapses  in  the  cases  declared  cured 
by  the  serum-treatment. 

In  other  diseases,  such  as  pyocyaneus  infection,  cholera, 
cerebrospinal  meningitis,  rabies,  hog-cholera,  and  swine- 
plague,  curative  sera  have  been  found  and  employed 
in  the  treatment  of  the  respective  diseases,  though  in 
most  of  these  the  amount  of  positive  information  ob- 
tained is  much  smaller  than  in  the  diseases  already  con- 
sidered. 

As  the  result  of  their  extensive  investigations  Ehrlich 
and  M orgenroth 2  conclude  that  it  is  advisable  to  im- 
munize different  species  of  animals  against  the  same 
poison,  and  then  employ  the  mixed  sera  of  these  immune 
animals  in  the  treatment  of  disease,  because  the  anti- 
bodies formed  in  the  blood  of  one  animal  species  differ 
from  those  formed  in  another,  and,  consequently,  a  mixed 
serum  would  be  more  likely  to  prove  beneficial  than  one 
derived  from  a  single  species.  The  mixed  complements, 
as  well  as  those  normally  present  in  the  human  body, 
can  then  be  brought  into  action.  It  is  reasonable  to 
suppose  that  herein  lies  the  cause  for  the  failure  or  lim- 
ited efficiency  of  some  of  the  antitoxic  sera  that  have  so 
far  been  manufactured. 

From  the  vast  amount  of  knowledge  at  hand  to-day  we 
are  still  not  in  a  position  to  give  a  satisfactory  explana- 
tion of  the  phenomena  of  immunity  in  general,  but  with 

1  St.  Louis  Medical  Gazette,  December,  1897.  2  Loc.  cit. 


350  VITAL  CAUSES  OF  DISEASE. 

regard  to  certain  diseases  we  are  in  a  position  to  state  the 
conditions  which  underlie  artificial  and  acquired  im- 
munity. In  others  we  know  but  little  as  to  the  causa- 
tive factors  in  their  production,  as  in  rubeola,  scarlatina, 
variola,  vaccinia,  and  varicella.  It  is  most  probable  that 
the  form  of  immunity  in  the  different  diseases  is  as  un- 
like as  the  diseases  themselves  are  unlike  in  their  nature 
and  character  of  lesions.  A  wide  field  of  research  remains 
unexplored  in  this  direction.  On  the  other  hand,  a  form 
of  infection  which  is  more  general  than  any  other,  that 
by  the  ordinary  pus-cocci,  and  in  which  the  immunity 
conferred  is  of  extremely  short  duration,  presents  con- 
ditions which  are  not  allied  to  those  found  in  other  dis- 
eases. The  actively  chemotactic  property  of  the  sta- 
phylococci is  not  encountered  in  the  infections  by 
most  of  the  other  bacteria,  or,  at  least,  only  to  a  slight 
extent. 

Contrary  to  the  generally  adopted  opinion  of  bacteri- 
ologists, Neisser  and  Wechsberg1  have  shown  very  defi- 
nitely that  the  staphylococci  produce  a  soluble  toxin  which 
is  very  closely  allied  in  its  constitution  to  the  toxins  pro- 
duced by  the  diphtheria  and  tetanus  bacilli.  They  found 
that  this  toxin  contained  two  distinct  poisons,  one  having 
an  affinity  for  the  red  blood-corpuscles  producing  hemo- 
lysis, and  the  other  an  affinity  for  leukocytes  and  other 
body-cells,  producing  degeneration  and  death  of  these 
cells.  They  found,  moreover,  that  there  was  a  variable 
quantity  of  staphylococci  antitoxin  pre-existing  in  the 
blood  of  human  beings  as  well  as  in  that  of  certain  ani- 
mals, and  that  it  was  possible  to  increase  to  a  consider- 
able degree  the  normal  antitoxic  content  of  rabbit's 
blood  by  the  injection  of  filtered  staphylococcus  cultures. 
They  found  that  the  toxin  produced  by  aureus  and 
albus  cultures  was  identical  in  constitution  and  action, 
and  that  both  were  neutralized  by  means  of  the  same 
antitoxin.  It  seems  quite  reasonable  to  expect,  there- 
fore, that  in  the  near  future  it  will  be  possible  to  treat 

1  Zeit.f.  Hyg.,  Bd.  xxxvi. 


PREVENTION  OF  INFECTION  BY  IMMUNITY.  35 1 

the  troublesome  staphylococcic  infections  by  means  of  a 
specific  antitoxin. 

Of  the  three  theories  of  immunity  held  at  the  present 
day,  it  is  evident  that  each  is  substantiated  by  both  clin- 
ical observation  and  experimental  results.  In  some  dis- 
eases one  appears  more  active  than  another,  but  no  doubt 
each  is  an  important  agent  in  the  production  of  the  phe- 
nomena of  immunity.  In  speaking  of  the  neutralizing 
effect  of  the  antitoxins  upon  the  bacterial  toxins,  it  must 
be  borne  in  mind  that  this  effect  is  only  a  relative  one, 
and  that  probably  the  antitoxins  act  by  stimulating  the 
leukocytes  or  the  tissue-cells,  or  both,  to  more  energetic 
reaction  against  the  bacteria  and  their  poisons.  The 
intimate  action  of  the  antitoxins  is  not  definitely  under- 
stood by  any  one. 

In  a  recent  contribution  Theobald  Smith l  states  that 
"the  action  of  antitoxin  appears  more  and  more  in  the 
light  of  a  true  chemical  action.  That  is  to  say,  these 
bodies  combine  with  one  another,  and  their  individuality 
is  thereby  destroyed.  This  combination  is  governed  by 
definite  quantitative  laws." 

Prevention  of  Infection  by  Inducing  Immunity. — 
An  enormous  amount  of  work  has  been  performed  to  dis- 
cover methods  of  preventing  the  action  of  pathogenic 
bacteria  by  means  of  their  metabolic  products  and  bv 
means  of  the  sera  of  immune  animals.  The  disease  in 
which  most  has  been  accomplished  in  this  direction  is 
diphtheria.  An  active  antitoxic  serum  is  not  only  cura- 
tive in  its  action  when  injected  into  a  patient  suffering 
from  the  disease,  but  it  is  also  a  most  important  prophy- 
lactic agent  when  injected  into  persons  that  have  been 
exposed  to  infection.  The  protection  afforded  by  the 
antitoxic  serum  of  diphtheria  is  of  rather  short  duration 
— two  or  three  weeks — but  it  is  sufficient  to  stamp  out 
an  outbreak  of  the  disease  in  institutions  in  which  large 
numbers  of  children  are  congregated.  Unless  the  im- 
munization is  followed  by  thorough  disinfection  of  the 

1  Jour,  of  the  Boston  Society  of  Medical  Sciences,  vol.  v.,  No.  1. 


352  VITAL  CAUSES  OF  DISEASE. 

premises,  the  disease  usually  recurs  after  the  immunity 
conferred  by  the  antitoxin  has  passed  away.  By  this, 
means  outbreaks  of  diphtheria  in  homes  for  children 
have  been  repeatedly  controlled,  and,  when  accompanied 
by  disinfection,  have  been  eradicated. 

The  use  of  the  metabolic  products  of  the  tubercle 
bacillus,  the  tuberculin  of  Koch,  in  the  treatment  of 
tuberculosis  was  not  attended  by  the  favorable  results  at 
first  expected.  This  agent  is,  however,  of  great  value  as 
a  diagnostic  agent  for  the  discovery  of  the  presence  of 
the  disease  in  the  early  stages  in  man  and  animals.  In 
this  manner  it  becomes  a  most  important  preventive 
agent  by  the  early  discovery  of  the  disease  in  cattle,  thus 
limiting-  the  danger  of  the  dissemination  of  the  disease 
through  infected  meat,  milk,  and  milk  products. 

The  valuable  results  obtained  in  the  prophylactic  treat- 
ment of  cattle  with  anthrax  vaccine — an  attenuated  cult- 
ure of  the  anthrax  bacillus  ;  the  prophylactic  treatment 
of  cattle  with  blackleg  virus — a  highly  attenuated  culture 
of  the  blackleg  bacillus  ;  as  well  as  other  animal  diseases 
which  are  treated  or  prevented  by  antitoxin  ;  and  the 
value  of  the  prophylactic  measures  against  small-pox  and 
diphtheria  as  practised  in  the  human  family,  lead  us  to 
hope  that  other  prophylactic  agents  may  be  discovered  to 
combat  outbreaks  of  infectious  diseases. 

Value  of  Vaccination  as  a  Protective  against 
Small-pox. — Erismann1  states  that  in  Prussia  at  the 
beginning  of  the  nineteenth  century,  before  vaccination 
became  general,  there  were  2000  to  3000  deaths  from 
small-pox  annually.  After  vaccination  was  made  com- 
pulsory the  death-rate  from  small-pox  was  reduced  to  200 
per  1,000,000  inhabitants  per  year;  and  since  the  law  of 
1874,  requiring  re-vaccination  in  schools  and  the  army, 
the  disease  is  still  rarer.  In  1894  there  were  88,  in  1895 
there  were  27,  and  in  1896  there  were  10  deaths  from 
small-pox.  The  results  in  neighboring  countries  are  as 
follows: 

1  Abst,  Centralblatt  f.  Bacteriologie,  Bd.  xxviii.,S.  617. 


VALUE  OF  VACCINATION. 


353 


Number  of  deaths  in 

1893. 

1894. 

1895. 

1896. 

Hungary     .... 

5821 
1224 

800  l 

837 
859 

1937 
2998 

865 
2039 

The  number  of  vaccinations  and  re-vaccinations  in 
Germany  in  1894,  the  kind  of  lymph  employed,  and  the 
results  obtained  are  shown  in  the  following  tables  : 2 

Vaccinations. 


Human. 

Animal. 

Not  stated. 

2023 
2030 

1,384,396 
1,136,660 

18,567 
4,331 

Total 

4053 
8212 

2,521,056 
2,421,208 

22,898 
18,554 

RESULTS. 

1.  Primary  Vaccinations. 

(a)  Successful 1,366,449 

(5)  Not  successful 21,446 

(c)  Result  unknown 3>I24 

Total I,39I,0I9 

2.  Re-vaccinations. 

(a)  Successful 1,074,797 

(6)  Not  successful 66,066 

(<r)   Result  unknown •    •  2,158 

Total 1,143,021 

Finkelburg3  discusses  the  dangers  from  vaccination  by 
means  of  bovine  lymph,  and  states  that  the  practical 
experiences  of  vaccine  physicians  teach  that  the  regula- 
tions for  the  production  of  the  lymph  are  not  altogether 
satisfactory  from  a  sanitary  standpoint,  and  advises 
"  (1)  the  introduction  of  a  simple  method  of  disinfection 
of  the  vaccination  field  and  of  the  instruments;  and  (2) 

1  Estimated. 

2  Abst,  Detttscke  Vierteljahrssch.  f.  oeffentliche  Gesundheitspflege,  Bel.  xxx. 

3  Centralblatt  f.  allgemeine  Gesundheitspflege,  Bd.  xviii.,  S.  357. 

23 


354  VITAL  CAUSES  OF  DISEASE. 

obligatory  direction  of  the  use  of  a  protective  bandage, 
which  is  applied  at  once  and  remains  in  position  until 
the  pustule  has  healed." 

According  to  Haase,1  when  the  vaccination  field  is  not 
washed,  31.45  per  cent,  of  the  vaccinations  present 
marked  reaction;  washing  with  soap  and  water  reduces 
the  number  to  22.63  per  cent.;  while  after  disinfection 
with  alcohol,  or  water,  soap,  and  alcohol,  none  of  the 
cases  showed  marked  reaction.  No  protective  bandage 
was  employed. 

Schoen 2  reports  on  small-pox  among  the  native  black 
races  of  Africa.  The  disease  is  generally  distributed 
along  the  upper  tributaries  of  the  Nile  in  Nubia,  Cordova, 
Abyssinia,  Soudan,  and  along  the  eastern  coast.  In 
Western  Africa  the  disease  is  less  generally  distributed 
because  there  is  less  intercourse  with  the  central  portion 
of  Africa  and  with  Asia.  At  times,  however,  the  disease 
is  introduced,  and  large  epidemics  and  pandemics  result, 
extending  over  entire  districts  and  tribes.  In  Bogamayo 
(East  Africa)  nearly  all  the  natives  are  pock-marked.  In 
1892,  Salaam  lost  10  per  cent,  of  its  inhabitants  from 
small-pox.  In  the  southern  portion  of  East  Soudan  an 
epidemic  destroyed  600  out  of  1400  members  of  a  tribe 
and  5  per  cent,  of  the  total  population.  According  to 
Steudel,  about  one-half  of  the  natives  die  of  small-pox  in 
Central  Africa.  According  to  Becker,  most  of  the  natives 
of  German  Africa  who  reach  the  age  of  manhood  have 
had  the  disease.  Compulsory  vaccination  is  the  only 
remedy,  according  to  Schoen. 

The  extremely  low  death-rate  from  small-pox  in  Ger- 
many indicates  the  importance  of  re-vaccinations  at  stated 
intervals.  It  is  also  evident  from  observations  in  England 
and  America  that  both  the  incidence  and  the  mortality 
of  the  disease  are  directly  proportional  to  the  protection 
afforded  by  vaccination  as  indicated  by  the  number  and 
distinctness  of  the  vaccination  marks. 

1  Zeilschrift  f.  Medizinalbeamte,  1899. 

2  Centralblatt  f.  Bacteriologie,  Bd.  xx.,  S.  641. 


VALUE  OF  VACCINATION. 


355 


Kronecker  1  gives  the  following  analysis  of  the  influence 
of  vaccination  upon  the  severity  of  small-pox: 


Number  of 

Number  of  vaccina- 

Severity  of  disease. 

Deaths. 

Light. 

Medium. 

Severe. 

8 

I  to  2 

7 

I 

14 

3  to4 

10 

I 

3 

10 

5  to  6 

9 

I2 

3 

Over  6 

2 

I 

4 

Distinct 

3 

I 

2 

Indistinct 

1 

I 

5 

None 

2 

3 

18 

None 

6 

2 

6 

4 

In  Gloucester,  England  (52, 500  inhabitants),  there  were 
2036  cases  of  small-pox  from  May,  1895,  to  July,  1896, 
of  which  443  died.  Vaccinated,  1228;  not  vaccinated, 
781;  unknown,  27.  Of  100  vaccinated,  9.2  died;  of  100 
non-vaccinated,  40.5  died;  of  100  "unknown,"  44.4 
died. 

In  Middleborough,  England  (90,000  inhabitants),  there 
were  1200  cases  of  small-pox  from  Nov.,  1897,  to  April, 
1898,  of  which  166  died  (=  13.8  per  cent.);  1028  had 
been  vaccinated,  of  which  87  (=8.46  per  cent.)  died; 
172  had  not  been  vaccinated,  of  which  79  (=45.93  per 
cent.)  died. 

Coupland 3  reports  on  small-pox  in — 

Dewsbury,  1891-92,  3000  cases  (=29.5  fc  of  population).  Died,  9.3  </0. 
Under  1  year,  33.3  f0  attacked;  died,  64  %■  From  I  to  10  years, 
attacked,  27.2  %  ;  died,  18  %.  From  10  to  30  years,  attacked,  35.2  fc  ; 
died,  5  f0.  Over  30  years,  attacked,  22.4  %;  died,  5.4  f0.  Primary 
vaccination,  79.8  f.  Of  those  dying,  16.6  f>  were  vaccinated.  Vac- 
cinated attacked,  24.  %;  non-vaccinated  attacked,  51.7  %.  Of  these, 
2.2  f0  died,  and  of  the  non-vaccinated  22.3  fo  died. 

I  eicester,  1893-94,  1234  cases  (=  25.3  fD  of  population).  Died,  25.3  f. 
Under  I  year,  21.8  %  attacked;  died,  28.5  %.  From  1  to  10  years, 
attacked,  28.9  %  ;  died,  10.5  %.  From  10  to  30  years,  attacked,  22.6  %  ; 
died,  2  %.  Over.  30  years,  attacked,  20.3  f0;  died,  3  f0.  Primary 
vaccination,  68.5  %.  Of  those  dying,  5.9  f0  were  vaccinated.  Vaccinated 
attacked.  20  %  ;  non-vaccinated  attacked,  38.4  %.  Of  these,  0.6  %  died, 
and  of  the  non-vaccinated,  10.7  fc  died. 

1  Abst,  Deutsche  Vierteljahrs.  f.  oeffentliche  Gesundheitspflege,  Bd.  xxxi. 

2  Not  stated.  3  Lancet,  1897. 


356  VITAL  CAUSES  OF  DISEASE. 

Gloucester,  1895-96,  4861  cases  (=  35.8  </c  of  population).  Died,  35.8  <f0- 
Under  1  year,  47.9  f0  attacked;  died,  70  <f0-  From  1  to  10  years, 
attacked,  39  f0  ;  died,  34.4  %■  From  10  to  30  years,  attacked,  33.9  f0  ; 
died,  8  f0.  Over  30  years,  attacked,  31. 9  f0;  died,  15. 1  <f0.  Primary 
vaccination,  69.6  c/0.  Of  those  dying,  25.7  f0  were  vaccinated.  Vac- 
cinated attacked,  30.3  f0  ;  non-vaccinated  attacked,  46.7  f0 .  Of  these, 
9.2  <fo  died,  and  of  the  non-vaccinaled,  40  <f0  died. 

Of  those  that  took  the  disease,  2.4  per  cent,  had  had  it 
previously.  It  was  markedly  milder  in  the  vaccinated, 
more  mild  the  more  recent  the  vaccination. 

In  the  epidemic  at  Hull,  England,  in  1899,1  there  were 
752  cases  from  March  1  to  December  30,  and  the  epi- 
demic was  still  in  progress.  The  case-mortality  had  been 
15.8  per  cent.  The  fatality  among  the  vaccinated  was 
9. 7  and  amongst  non-vaccinated  50  per  cent. 

The  Haffkine  Method  of  Protection.— The  Haff- 
kine  method  of  protection  and  treatment  of  typhoid 
fever,  cholera,  and  bubonic  plague  by  means  of  heated 
cultures  of  the  respective  organisms  has  been  found  of 
great  value  in  these  diseases.  The  protection  of  Eng- 
lish soldiers  and  army  nurses  against  typhoid  fever  by 
this  method  of  inoculation  appears  to  have  been  of 
signal  benefit  during  the  past  few  years.  It  has  been  the 
experience  of  English  army  surgeons  in  South  Africa  that 
where  heretofore  nurses  in  the  army  hospitals  frequently 
contracted  typhoid  fever  from  patients,  that  since  the 
introduction  of  this  method  of  protection  the  danger  of 
infection  of  nurses  has  been  practically  eliminated. 

The  prophylactic  agents  employed  act  in  different  ways. 
The  vaccine,  and  the  anthrax  and  blackleg  viruses,  act 
by  inducing  a  mild  type  of  the  disease,  and  in  this  man- 
ner confer  immunity.  The  metabolic  products  of  the 
bacteria  when  injected  into  an  animal  cause  the  forma- 
tion of  the  antitoxic  principle  in  the  blood  of  the  animal, 
and  this  renders  it  immune.  The  antitoxic  sera  confer 
immunity  directly,  but  this  form  of  immunity  can  last 
onlv  so  lonsr  as  the  antitoxin  is  circulating  in  the  blood 
or  forms  a  part  of  the  body,  which  is  usually  only  a 
short  time. 

1  Brit.  Med.  Jour.,  1899. 


PERSONAL  PROPHYLAXIS.  357 

Personal  Prophylaxis. — In  treating  cases  of  infec- 
tious diseases,  it  is  inadvisable  for  the  physician  to  wear 
specially  constructed  suits  for  his  protection  against  in- 
fection. There  are,  however,  a  number  of  precautionary 
measures  that  should  be  taken.  The  physician  may 
wear  a  linen  duster  or  operating-coat  over  his  clothing 
while  in  the  sick-room,  since  this  will  not  be  so  likely 
to  alarm  the  patient,  and  will  serve  in  a  large  measure  to 
keep  infective  materials  from  his  own  clothing.  This 
coat  should  be  left  in  an  ante-room  or  just  outside  the 
door  of  the  sick-room,  and  should  be  disinfected  after 
each  visit  in  such  diseases  as  small-pox  and  scarlet  fever. 
He  should  time  his  visits  so  as  to  have  a  full  stomach, 
and  should  spend  as  much  time  as  possible  in  the  open 
air  subsequently.  He  should  secure  at  least  eight  hours 
of  sleep,  so  as  to  maintain  his  physical  vigor.  He  should 
abstain  from  the  use  of  alcoholic  beverages.  Personal 
cleanliness  is  of  the  greatest  importance,  and  daily  baths 
are  to  be  recommended.  Great  care  should  be  taken  in 
keeping  the  hands  and  nails  scrupulously  clean,  and  it  is 
advisable  for  the  physician  to  wash  his  hands  imme- 
diately after  handling  the  patient.  There  is  no  doubt 
that  many  physicians  have  lost  their  lives  in  consequence 
of  neglect  of  this  point.  This  is  especially  true  of 
typhoid  fever,  where  the  patient's  body  and  clothing  are 
soiled  by  fecal  matter  and  urine.  The  same  precautions 
apply  with  equal,  or  even  greater,  force  to  the  nurse. 
Drugs  have  no  influence  whatever  in  warding  off  disease, 
though  there  is  a  widespread  belief  to  the  contrary  among 
the  laity. 

In  the  following  table  an  attempt  has  been  made  to 
present  in  concise  form  the  more  important  points  with 
regard  to  the  direction  in  which  it  is  necessary  to  extend 
our  energies  in  controlling  the  principal  infectious  dis- 
eases. Not  all  of  the  preventive  measures  employed  in 
the  different  diseases  are  here  given,  but  only  those  which 
are  deemed  to  be  the  leading  measures.  The  details  with 
regard  to  the  special  modes  of  disinfection   adapted  to 


353 


VITAL  CAUSES  OF  DISEASE. 


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360  VITAL  CAUSES  OF  DISEASE. 

the  more  important  of  these  diseases  are  given  in  the 
chapter  on  Disinfection. 

Persistence  of  Pathogenic  Bacteria  in  Dead 
Bodies. — The  possible  danger  of  the  infection  of  the  soil 
and  water  through  pathogenic  bacteria  derived  from  dead 
bodies  after  burial  has  been  frequently  discussed.1  Klein 
has  made  a  practical  investigation  of  the  subject.  He 
inoculated  guinea-pigs  intraperitoneally  with  different 
organisms,  and  after  death  they  were  wrapped  in  cotton, 
placed  in  small  wooden  or  tin  boxes,  or  without  these, 
and  buried  in  moist  earth  or  sand.  When  exhumed,  the 
abdominal  cavity  of  the  animals  was  opened  and  washed 
out  with  1  or  2  cubic  centimeters  of  sterile  salt  solution, 
and  this  fluid  was  used  to  make  cultures.  Bacillus  pro- 
digiosus  and  Staphylococcus  aureus  were  found  alive 
after  twenty-eight  days,  but  had  disappeared  entirely  in 
six  to  eight  weeks.  Cholera  organisms  were  found  alive 
after  nineteen  days,  but  had  disappeared  after  twenty- 
eight  days.  Similar  results  were  obtained  with  typhoid, 
diphtheria,  and  plague  bacilli.  Tubercle  bacilli  died 
during  the  first  seven  weeks. 

These  results  indicate  that  there  is  danger  of  the  con- 
tamination of  the  soil  and  water  in  the  vicinity  of  ceme- 
teries when  the  bodies  of  those  dying  from  infectious  dis- 
eases are  not  disposed  of  in  a  proper  manner.  The  bodies 
should  be  wrapped  in  sheets  moistened  with  1  :  1000 
bichlorid  of  mercury  solution,  or  5  per  cent,  carbolic 
acid  solution;  all  the  orifices  should  first  be  efficiently 
plugged.  The  bodies  should  be  placed  in  hermeti- 
cally sealed  coffins,  so  that  there  is  no  possibility  for  the 
infectious  material  to  escape.  Cremation  would  be  the 
quickest  and  safest  method  of  disposal  of  the  bodies  of 
persons  dying  of  infectious  diseases,  but  this  mode  of 
disposal  is  objectionable  to  many  persons. 

Prevention  of  Malaria.— As  was  shown  by  Smith 
and  Kilborne,  and  substantiated  by  Koch,  certain  in- 
sects   are    the    carriers   of    the   infective   organisms    of 

1  Centralbl.  f.  Bacteriologie,  Bd.  xxv.,  S.  727. 


PRE  VENTION  OF  MALARIA. 


361 


Texas  cattle  fever.  Manson  and  Ross  have  demonstrated 
that  a  certain  kind  of  fly  is  the  carrier  of  infection  for 
birds,  and  that  certain  species  of  mosquitoes  are  the  car- 
riers of  the  malarial  infection  for  human  beings.  They 
found  the  evolution  cycles  of  the  resistant  form  of  the 
malaria  parasites  in  the  bodies  of  Anopheles,  while  in 
man  the  parasites  assume  the  asportation  phase,  so  that 
man  is  merely  the  temporary  host  of  the  parasites.  Ac- 
cording to  Mattei,1  the  evolution  cycle  of  the  malaria 
parasites  consists,  therefore,  of  a  chain  of  two  rings — 
man  and  the  mosquito — man  infected  with  malaria  infects 


1  2 

Fig.  57. — Mosquitoes — Culex  (1)  and  Anopheles  (2). 


healthy  mosquitoes,  and  the  infected  mosquitoes  infect 
healthy  persons,  thus  completing  the  cycle. 

The  species  of  mosquito  which  appears  to  be  princi- 
pally, if  not  entirely,  concerned  in  carrying  malarial  in- 
fection to  man  is  the  Anopheles.  Mattei  found  that 
protection  against  mosquitoes  by  means  of  wire  screens 
at  windows  and  doors,  and  mosquito-netting,  served  to 
protect  against  malaria  while  sojourning  in  malarious 
localities.  Sambon  and  Low,  of  the  London  School 
of  Tropical  Medicine,  demonstrated  the  same  thing 
while  living  in  notoriously  malarious  localities  in  Italy. 
Dr.  Elliott,   a  member  of  the  Liverpool  Expedition  to 

1  Centra  Ibl.  f.  Bacteriologie,  Bd.  xxviii.,  S.  189. 


362  VITAL  CAUSES  OF  DISEASE. 

West  Africa,  and  Prof.  Grassi,1  the  leader  of  an  Italian 
expedition  to  the  plains  of  Capaccio,  Italy,  report  similar 
results.  Wire  screens  and  mosquito-netting  were  found 
to  exclude  the  Anopheles  from  habitations,  but  failed 
to  exclude  the  non-infecting  Culex. 

Manson 2  reports  a  most  interesting  experiment  demon- 
strating the  direct  relation  of  mosquitoes  to  malarial  in- 
fection. He  reports  the  successful  inoculation  in  L,ondon 
with  malaria  of  an  uninfected  individual  by  means  of 
mosquitoes  brought  from  Italy.  The  subject,  Dr.  Hanson's 
son,  submitted  on  three  occasions  to  the  bites  of  the 
imported  and  infected  mosquitoes,  with  the  result  that 
within  a  few  days  after  the  third  inoculation  symptoms 
of  tertian  malarial  fever  appeared,  together  with  the 
presence  of  the  corresponding  parasites  in  the  blood. 
Relief  was  promptly  afforded  by  the  administration  of 
quinin.  Similar  observations  are  said  to  have  been  made 
in  New  York  City  on  a  patient  in  Bellevue  Hospital,  who 
volunteered  for  the  purpose  of  the  experiment. 

Prevention  of  Yellow  Fever. — The  theory  of  the 
propagation  of  yellow  fever  by  mosquitoes  was  advanced 
by  Dr.  Carlos  J.  Finlay,  of  Havana,  as  early  as  188 1.  In 
a  preliminary  report  of  the  investigations  of  a  commis- 
sion sent  to  Cuba  by  the  Surgeon-General  of  the  U.  S. 
Army,  to  study  yellow  fever,  which  Dr.  Walter  Reed  pre- 
sented before  the  American  Public  Health  Association  at 
Indianapolis,  Ind.,  October  24,  1900,  are  brought  forward 
most  interesting  and  important  facts  with  regard  to  this 
mode  of  dissemination  of  the  disease.  These  investiga- 
tions by  the  commission  confirm  the  observations  of  Dr. 
Henry  R.  Carter,  Surgeon  of  the  Marine-Hospital  Ser- 
vice at  Orwood  and  Taylor,  Miss.,  that  "the  period  from 
the  first  (infecting)  case  to  the  first  group  of  cases  in- 
fected at  these  houses  (isolated  farm-houses)  is  generally 
from  two  to  three  weeks."  After  the  houses  had  become 
infected   susceptible   individuals   thereafter  visiting  the 

1  Centralbl.  f.  Bacteriologie,  Bd.  xxviii.,S.  535- 

2  British  Medical  Journal,  Sept.  29,  1 900,  p.  949. 


PRE  VENTION  OF  YELLO  W  FE  VER.  363 

houses  for  a  few  hours  fall  sick  with  the  disease  in  the 
usual  period  of  incubation, — one  to  seven  days.1 

Other  observations,  made  by  Reed  and  his  assistants  in 
Cuba,  confirmed  Dr.  Carter's  conclusions,  "  thus  pointing, 
as  it  seemed  to  us,  to  the  presence  of  an  intermediate 
host,  such  as  the  mosquito,  which,  having  taken  the 
parasite  into  its  stomach,  soon  after  the  entrance  of  the 
patient  into  the  non-infected  house,  was  able  after  a  cer- 
tain interval  to  convey  the  infecting  agent  to  other  indi- 
viduals, thereby  converting  the  non-infected  house  into 
an  '  infected '  house.  This  interval  would  appear  to  be 
from  nine  to  sixteen  days  (allowing  for  the  period  of  in- 
cubation), which  agrees  fairly  closely  with  the  time  re- 
quired for  the  passage  of  the  parasite  from  the  stomach 
of  the  mosquito  to  its  salivary  glands." 

The  members  of  the  Yellow  Fever  Commission  of  the 
Liverpool  School  of  Tropical  Medicine,  Drs.  Durham 
and  Meyers,  were  impressed,  also,  with  the  importance 
of  Dr.  Carter's  observations.2 

The  species  of  mosquito  which  serves  as  the  inter- 
mediate host  in  yellow  fever  has  been  identified  by  L.  O. 
Howard,  Ph.D.,  Entomologist,  Department  of  Agricul- 
ture, Washington,  D.  C,  as  Culex  fasciatus,  Fabr. 

The  present  views  of  Dr.  Finlay  on  this  subject  are  as 
follows:  "First,  reproduction  of  the  disease,  in  a  mild 
form,  within  from  five  to  twenty-five  days  after  having 
applied  contaminated  mosquitoes  to  susceptible  subjects. 
Second,  partial  or  complete  immunity  against  yellow 
fever  obtained  even  when  no  pathogenous  manifestations 
had  followed  these  inoculations."  3 

Reed  and  his  assistants  failed  to  find  any  specific  micro- 
organisms in  the  blood  of  yellow-fever  patients,  nor  in 
the  cadavers  of  yellow-fever  subjects.  They  were  able, 
however,  to  inoculate  the  disease  successfully  by  means 
of  infected  mosquitoes  in  non-immune  subjects  after  ten 

1  Philadelphia  Medical  Journal,  October  27,  1900. 

2  British  Medical  Journal,  pp.  656-7,  September  8,  1900. 

3  Medical  Record,  vol.  lv.,  No.  21,  May  27,  1899. 


364  VITAL  CAUSES  OF  DISEASE. 

to  twelve  days  had  elapsed  from  the  time  of  stinging 
yellow-fever  patients  ;  the  period  of  incubation  was  the 
usual  one,  and  the  symptoms  developed  were  typical. 

These  facts  tend  to  explain  many  of  the  points  that 
were  obscure  heretofore  ;  notably,  the  fact  that  frost 
arrests  the  spread  of  yellow  fever.  This  fact  is,  no 
doubt,  due  to  the  destruction  of  infected  mosquitoes  by 
the  frost.  The  immunity  of  the  pine  belt  of  the  South- 
ern States  may  also  be  explained  by  the  fact  that  in 
these  regions  the  conditions  of  life  and  multiplication 
are  unfavorable  to  mosquitoes. 

The  United  States  Government  has  formally  recognized 
the  influence  of  mosquitoes  in  the  transmission  of  yellow 
fever,  malaria,  and  filariasis.  A  general  order  has  been 
issued  by  Major-General  Wood,  at  Havana,  to  the  differ- 
ent post  commanders,  in  which  the  troops  are  enjoined 
to  observe  carefully  two  precautions:  "  1.  They  are  to 
use  mosquito-bars  in  all  barracks,  hospitals,  and  field- 
service  whenever  practicable.  2.  They  are  to  destroy 
the  larvae  or  young  mosquitoes  by  the  use  of  petroleum 
on  the  waters  where  they  breed.  Permanent  pools  or 
puddles  are  to  be  filled  up.  To  the  others  are  to  be 
applied  one  ounce  of  kerosene  to  each  15  square  feet  of 
water  twice  a  month,  which  will  destroy  not  only  the 
young,  but  the  old  mosquitoes.  This  does  not  injure 
drinking-water  if  drawn  from  below  and  not  dipped  out. 
Protection  is  thus  secured,  according  to  the  order,  because 
the  mosquito  does  not  fly  far,  seeks  shelter  when  the 
wind  blows,  and  thus  each  community  breeds  its  own 
mosquitoes."1 

The  proper  measures  of  prophylaxis  are  given  in  the 
following  circular,  which  has  recently  been  published  by 
the  Commanding  General  of  the  Medical  Corps  of  the 
Army : 

"Upon  the  recommendation  of  the  Chief  Surgeon  of  the 
Department,  the  following  instructions  are  published  and  will  be 
strictly  enforced  at  all  military  posts  in  this  Department : 

1  Jour.  Am.  Med.  Assoc,  January  5,  1901. 


PRE  VENTION  OF  YELLO  W  FE  VER.  365 

"  The  recent  experiments  made  in  Havana  by  the  Medical 
Department  of  the  Army  having  proved  that  yellow  fever,  like 
malarial  fever,  is  conveyed  chiefly,  and  probably  exclusively,  by 
the  bites  of  infected  mosquitoes,  important  changes  in  the 
measures  used  for  the  prevention  and  treatment  of  this  disease 
have  become  necessary. 

"  1.  In  order  to  prevent  the  breeding  of  mosquitoes  and  pro- 
tect officers  and  men  against  their  bites,  the  provisions  of  General 
Orders  No.  6,  Department  of  Cuba,  December  21,  1900,  shall  be 
carefully  carried  out,  especially  during  the  summer  and  fall. 

"2.  So  far  as  yellow-fever  is  concerned,  infection  of  a  room  or 
building  simply  means  that  it  contains  infected  mosquitoes — that 
is,  mosquitoes  which  have  fed  on  yellow  fever  patients.  Disin- 
fection, therefore,  means  the  employment  of  measures  aimed  at  the 
destruction  of  these  mosquitoes.  The  most  effective  of  these 
measures  is  fumigation,  either  with  sulphur,  formaldehyd,  or 
insect  powder.  The  fumes  of  sulphur  are  the  quickest  and  most 
effective  insecticide,  but  are  otherwise  objectionable.  Formaldehyd 
gas  is  quite  effective  if  the  infected  rooms  are  kept  closed  and 
sealed  for  two  or  three  hours.  The  smoke  of  insect  powder  has 
also  been  proved  very  useful ;  it  readily  stupefies  mosquitoes, 
which  drop  to  the  floor  and  can  then  easily  be  destroyed. 

"  The  washing  of  walls,  floors,  ceilings,  and  furniture  with  dis- 
infectants is  unnecessary. 

"3.  As  it  has  been  demonstrated  that  yellow  fever  cannot  be 
conveyed  by  fomites,  such  as  bedding,  clothing,  effects,  and 
baggage,  they  need  not  be  subjected  to  any  special  disinfection. 
Care  should  be  taken,  however,  not  to  remove  them  from  the 
infected  rooms  until  after  formaldehyd  fumigation,  so  that  they 
may  not  harbor  infected  mosquitoes. 

"  Medical  officers  taking  care  of  yellow-fever  patients  need  not 
be  isolated  ;  they  can  attend  other  patients  and  associate  with 
non-immunes  with  perfect  safety  to  the  garrison.  Nurses  and 
attendants  taking  care  of  yellow-fever  patients  shall  remain 
isolated,  so  as  to  avoid  any  possible  danger  of  their  conveying 
mosquitoes  from  patients  to  non-immunes. 

"  4.  The  infection  of  mosquitoes  is  most  likely  to  occur  during 
the  first  two  or  three  days  of  the  disease.  Ambulant  cases — that 
is,  patients  not  ill  enough  to  take  to  their  bed — and  remaining 
unsuspected  and  unprotected,  are  probably  those  most  responsible 
for  the  spread  of  the  disease.  It  is  therefore  essential  that  all 
fever  cases  should  be  at  once  isolated  and  so  protected  that  no 
mosquitoes  can  possibly  get  access  to  them  until  the  nature  of  the 
fever  is  positively  determined. 

"  Each  post  shall  have  a  '  reception  ward  '  for  the  admission  of 
all  fever  cases,  and  an  '  isolation  ward  '  for  the  treatment  of  cases 
which  prove  to  be  yellow  fever.  Each  ward  shall  be  made 
mosquito-proof  by  wire  netting  over  doors  and  windows,  a  ceiling 
of   wire  netting  at  a  height  of  seven  feet  above  the  floor,  and 


366  VITAL  CAUSES  OF  DISEASE. 

mosquito-bars  over  the  beds.  There  should  be  no  place  in  it  where 
mosquitoes  can  seek  refuge,  not  readily  accessible  to  the  nurse. 
Both  wards  can  be  in  the  same  building,  provided  they  are  sep- 
arated by  a  mosquito-tight  partition. 

"5.  All  persons  coming  from  an  infected  locality  to  a  post 
shall  be  kept  under  careful  observation  until  the  completion  of 
five  days  from  the  time  of  possible  infection,  either  in  a  special 
detention  camp  or  in  their  own  quarters  ;  in  either  case,  their 
temperature  should  be  taken  twice  a  day  during  this  period  of 
observation,  so  that  those  who  develop  yellow  fever  may  be  placed 
under  treatment  at  the  very  inception  of  the  disease. 

"6.  Malarial  fever,  like  yellow  fever,  is  communicated  by 
mosquito  bites,  and  therefore  is  just  as  much  of  an  infectious  dis- 
ease, and  requires  the  same  measures  of  protection  against  mosqui- 
toes. On  the  assumption  that  mosquitoes  remain  in  the  vicinity 
of  their  breeding-places,  or  never  travel  far,  the  prevalence  of 
malarial  fever  at  a  post  would  indicate  want  of  proper  care  and 
diligence  on  the  part  of  the  Surgeon  and  Commanding  Officer  in 
complying  with  General  Orders  No.  6,  Department  of  Cuba,  1900. 

"7.  Surgeons  are  again  reminded  of  the  absolute  necessity  in 
all  fever  cases  to  keep,  from  the  very  beginning,  a  complete 
chart  of  pulse  and  temperature,  since  such  a  chart  is  their  best 
guide  to  a  correct  diagnosis  and  the  proper  treatment." 

Extermination  of  the  mosquito  in  Havana  resulted  in 
the  virtual  eradication  of  yellow  fever.  In  an  official 
report  Major  W.  C.  Gorgas,  of  the  Army  Medical  Depart- 
ment, who  is  chief  sanitary  officer  of  General  Wood's 
staff,  says  : 

"We  commence  June  with  the  city  free  from  yellow 
fever,  no  cases  being  on  hand.  This  is  probably  the  first 
time  Havana  has  ever  entered  June  free  from  yellow 
fever.     April  and  May  also  commenced  in  the  same  way. 

"Formerly  we  paid  no  particular  attention  to  the 
mosquito,  merely  disinfecting  for  yellow  fever,  as  we  do 
for  other  infectious  diseases.  The  amount  of  sanitary 
work  done  formerly  continues,  but  most  of  our  attention 
is  now  being  paid  to  the  destruction  of  mosquitoes. 

''The  suburbs  and  the  small  streams  in  the  suburbs 
have  been  thoroughly  cleaned  out,  and  pools  have  been 
oiled  and  drained.  The  Mayor  has  issued  an  order  pro- 
hibiting the  keeping  of  standing  water  within  the  city 
limits     unless    made     mosquito-proof.      This    is    being 


EXTERMINA  TION  OF  RA  TS.  367 

enforced,  and  all  standing  water  found  not  protected  is 
emptied  and  the  owner  fined." 

The  Destruction  of  Mosquitoes  in  the  City C.  Fermi 

and  S.  Lumbao1  give  brief  biologic  notes  on  the  mos- 
quitoes which  most  commonly  infest  cities.  As  insecti- 
cides against  mosquito  larvae,  the  authors  used  petroleum 
and  chrysanthemum  powder  with  good  success.  Several 
substances  were  experimented  with  for  the  purpose  of 
discovering  means  for  the  prevention  of  the  too  rapid 
evaporation  of  petroleum  from  the  surface  of  infested 
water.  The  substances  which  were  spread  upon  the 
surface  of  the  petroleum  for  this  purpose  were  lanolin, 
vaselin,  tar,  naphtalin,  olive  oil,  flaxseed  oil,  castor  oil, 
and  lard.  Vaselin  and  tar  spread  rapidly  over  the  sur- 
face of  the  oil  without  coagulating.  A  large  number  of 
plant  substances  were  tried  in  combination  with  chrys- 
anthemum powder  in  the  destruction  of  mosquito  larvae. 
For  the  destruction  of  adult  mosquitoes  the  authors  tried 
fumigation  with  a  number  of  substances,  anions'  which 
the  following  gave  the  best  results  :  chloroform,  turpen- 
tine and  vinegar,  sulphuric  ether,  tobacco  fumes,  and 
eucalyptus  fumes. 

During  the  experiments  with  petroleum  it  was  found  that 
5  c.  c.  per  square  meter  of  water  surface  killed  all  mosquito 
larvae.  It  was  not  found  necessary  to  renew  the  kerosene 
upon  the  surface  oftener  than  once  in  fourteen  days. 

The  extermination  of  rats,2  because  they  are  the 
carriers  of  plague-infection,  seems  fast  becoming  a  duty 
of  all  civilized  governments.  The  Local  Government 
Board  of  Kngland  recognizes  this  fact  in  a  circular  to  the 
sanitary  authorities  on  the  risk  of  importing  the  disease 
by  means  of  ships  infested  with  plague-infected  rats  and 
the  precautions  necessary  to  prevent  such  introduction. 
On  other  grounds  it  would  be  well  if  these  justly  de- 
tested animals  could  all  be  killed.  These  pests  have 
been  supposed  to  be  scavengers,  but  the  answer  to  the 

1  Centrbl.f.  Bad.,  I  abst.,  pp.  179-185,  1900. 

2  American  Medicine,  vol  i.,  1 901. 


368  VITAL  CA  USES  OF  DISEASE. 

plea  is  that  the  filth  upon  which  they  live  is  unnecessary, 
and  even  a  danger. 

Simon  believes  the  infection  is  due  to  the  fleas  with 
which  rats  are  commonly  infested;  but  Dr.  Nuttall,  who 
has  made  an  extensive  study  of  the  subject,  claims  that 
his  researches  do  not  bear  out  Simon's  theory.  Prof.  Ash- 
burton  Thompson,  in  an  account  of  the  plague  in  New 
South  Wales,  says  that  he  is  convinced  the  disease  reached 
Sidney  through  the  rats  on  vessels  from  Noumea,  at 
which  place  the  plague  existed.  His  investigations  lack 
a  connecting  link  between  rats  and  man,  and  the  hypoth- 
esis that  infection  is  conveyed  by  a  suctorial  insect  infect- 
ing rats  and  transferable  to  man  would  furnish  this  link. 
Certain  it  is  that  rats  are  easily  inoculable,  and  that  they 
do  carry  the  disease  over  the  world.  Their  ingenuity 
and  pertinacity  in  infesting  all  ships  and  the  unsanitary 
quarters  of  all  cities  are  most  remarkable.  The  medical 
commission  of  the  Japanese  Government  says  that  to 
avoid  the  spread  of  bubonic  plague  rats  must  be  exter- 
minated. But  this  is  plainly  an  almost  impossible  task. 
It  would,  however,  seem  possible  to  kill  them  on  ships 
from  infected  ports.  An  effective  method  of  doing  this 
has  been  suggested  by  means  of  sulphurous  acid  forced 
into  all  parts  of  the  vessel  for  twenty-four  hours. 

Extermination  of  rats,  by  means  of  the  generation  of 
sulphurous  acid  gas  of  a  high  strength,  has  been  success- 
fully tried  on  the  "Jelunga,"  a  steamer  of  the  British 
India  line.  The  apparatus  used  was  a  small  cylinder  in 
which  rolled  sulphur  was  burned  until  it  vaporized  and  air 
being  admitted  into  the  chamber  where  this  vaporizing 
took  place  the  combination  of  oxygen  and  sulphur  vapors 
furnished  the  sulphur  dioxid  gas.  The  hatches  of  the 
"Jelunga  "  were  closed  and  the  gas  admitted.  The  space 
to  be  operated  on  held  2100  cubic  meters.  The  next  day 
when  the  vessel  was  opened  dead  rats  were  lying  about 
and  all  other  forms  of  vermin  were  extinct. 

The  Animal  and  Vegetable  Parasites. — The  animal 
parasites  may  be  divided  into  two  classes,   the  ectozoa. 


PREVENTION  OF  INFECTION  WITH  ANIMALS.  369 

and  the  entozoa  and  hematozoa,  with  regard  to  the  loca- 
tion of  the  parasite  in  the  human  body. 

The  principal  ectozoa  are:  1.  The  itch  mite — Sar- 
coptes  scabiei;  2.  The  chigger,  or  sandflea — Pulex  pene- 
trans; 3.  The  screw-worm — Lucilia  macellaria;  4.  Ver 
macque — Dermatobia  noxialis;  5.  Filaria  medinensis;  6. 
Argus  Persica;  7.   Leeches;  8.   Pediculi. 

The  principal  entozoa  and  hematozoa  are:  1.  Bilharzia 
haematobia.  2.  Filaria  sanguinis  hominis.  3.  Plasmo- 
dium inalariae.  4.  Distomum  Ringeri.  5.  Nematodes 
— a.  Tricocephalus  dispar;  b.  Ascarus  lumbricoides;  c. 
Ankylostoma  duodenale;  d.  Rhabdonema  intestinale;  e. 
Strongylus  subtilis.  6.  Trematodes — a.  Amphistomum 
hominis;  b.  Distomum  Buski;  c.  Distomum  heterophyes. 
7.  Cestodes — a.  Taenia  nana;  b.  Taenia  solium;  c.  Taenia 
mediocanellata;  d.  Taenia  Madagascarensis;  e.  Bothrio- 
cephalus  Mansoni;  f.  Larvae  of  dipterous  insects.  8. 
Echinococcus.  9.  Fasciola  hepatica.  10.  Distoma  hepat- 
ica.      11.  Trichina  spiralis.      12.   Ameba  of  dysentery. 

The  principal  vegetable  parasites  are:  1.  Tinea  tricho- 
phyton. 2.  Achorion  Schonleinii.  3.  Aspergillus  ni- 
gricans. 4.  Mycetoma,  or  Madura  foot.  5.  Dhobie  itch. 
6.    Pinta.      7.   Piedra. 

Most  of  the  animal  parasites  are  contracted  by  drink- 
ing polluted  water,  bathing  in  grossly  polluted  water,  or 
in  eating  uncooked  vegetables  that  are  infected  with  the 
excrement  of  man  and  animals.  Some  of  these  diseases 
are  also  contracted  by  eating  the  meat  of  infected  ani- 
mals. One  stage  of  the  life-cycle  of  the  intestinal  worms 
is  passed  in  the  body  of  some  one  of  the  domestic  ani- 
mals, and  association  with  such  animals  is  frequently 
sufficient  to  become  infected. 

Prevention  of  Infection  with  Animal  Parasites. — 
In  a  paper  presented  to  the  International  Congress  of 
Hygiene  (1891,  vol.  1),  Dr.  Prospero  Sonsino  gives 
succinct  directions  for  preventing  this  form  of  infection: 

"  1.  Pure  spring- water,  or  else  boiled  or  filtered  water, 
alone  are  to  be  drunk.      Drinking-water  is  to  be  preserved 

24 


370  VITAL  CAUSES  OF  DISEASE. 

in  good  and  well-covered  vessels.  River-  or  lake-water 
not  to  be  imbibed  while  bathing.  This  rule  regards  pre- 
vention especially  from  Bilharzia  haematobia,  Filaria  san- 
guinis hominis,  Ranunculus  medinensis,  Rhabdonema  in- 
testinale,  and  probably  from  Filaria  loa  and  many  others. 
The  relatively  large  dimensions  of  the  eggs  and  larval 
stage  of  entozoa  hinder  their  passage  with  drinking- 
water  through  a  good  filter;  therefore  proper  filtration 
of  drinking-water  suffices. 

' '  2.  Meat,  fresh-water  fish,  and  vegetables  are  to  be  well 
cooked  and  kept  from  insects  (flies).  For  children  and 
invalids,  raw  meat  can  be  used,  provided  that  it  is  well 
pounded  and  passed  through  a  suitable  sieve.  This  rule 
regards  prevention  especially  from  Trichina  spiralis, 
Taenia  solium,  T.  saginata  (mediocanellata),  Bothrio- 
cephalus  latus,  Ascarus  lumbricoides,  A.  mystax,  Dis- 
toma  lanceolatum,  Fasciola  hepatica,  and  others.  The 
modern  use  of  raw  beef  for  children  and  invalids  has 
been  the  cause  of  an  extraordinary  spread  of  Taenia 
saginata. 

"Depraved  tastes  for  substances  not  possessed  of  ali- 
mentary qualities  (pica  and  geophagia)  are  not  to  be  yielded 
to.  This  rule  regards  the  prevention  from  Taenia  nana, 
leptocephalia,  canina,  and  probably  from  Distoma  hetero- 
phyes,  Echinorhynchus  hominis,  Ascarus  lumbricoides, 
A.  mystax.  Many  of  these  entozoa  have,  or  are  sus- 
pected to  have,  insects  as  intermediary  hosts,  which  may 
be  conveyed  to  the  stomach  of  man  through  the  habit  of 
those  affected  with  pica  and  geophagia  of  eating  dirty 
things. 

' '  4.  Special  forms  of  food  in  use  by  the  natives  of 
countries  possessing  special  entozoa  are  to  be  avoided,  or 
only  taken  after  thorough  cooking.  This  rule  is  calcu- 
lated to  prevent  Bothriocephalus  cordatus,  B.  Mansoni, 
Distoma  crassum,  D.  heterophyes,  D.  sinense,  and  D. 
Ringeri. 

"  5.  Hands  and  nails  are  to  be  kept  thoroughly  clean, 
particularly  when  about  to  eat.     Domestic  animals  are  to 


PREVENTION  OF  INFECTION  WITH  ANIMALS.  371 

be  handled  with  caution — dogs  especially.  Caution  in 
handling  entozoa;  their  speedy  and  complete  destruction 
by  fire  whenever  it  is  not  necessary  to  preserve  them  for 
medical  purposes.  This  rule  is  of  great  importance, 
especially  for  preserving  man  from  Anchylostoma  duod- 
enale,  echinococcus,  Pentostoma  denticulatum,  Taenia 
canina,  T.  solium,  and  Oxyuris  vermicularis. 

' '  6.  The  body  is  to  be  kept  free  from  epizoa  (mosqui- 
toes, bugs,  fleas,  etc.).  This  rule  is  of  great  importance 
in  guarding  against  some  of  the  above-mentioned  worms, 
so  as  to  interfere  with  the  life-cycle  of  those  parasites,  as 
well  as  with  that  of  several  of  the  filariae." 

It  is  safe  to  assume  that  protection  against  epizoa  will 
be  of  value  in  preventing  infection  from  a  number  of 
other  diseases  the  specific  causes  of  which  are  as  yet  un- 
determined. Our  knowledge  with  regard  to  the  dis- 
semination of  disease  by  means  of  insects  has  been  care- 
fully summarized  by  Xuttall.1 

1  Johns  Hopkins  Bulletin. 


CHAPTER   XVIII. 
DISINFECTION. 

Aside  from  the  prophylactic  measures  already  spoken 
of,  there  are  other  measures  in  common  use  to  limit  the 
spreading  of  the  infectious  diseases.  These  measures  are 
employed  to  destroy  the  specific  bacteria  and  other  in- 
fective aeents  outside  the  bodv.  These  measures  are 
commonly  included  under  the  broad  term  disinfection. 
To  disinfect  is  to  render  non-infective,  and  a  disinfectant 
is,  therefore,  any  agent  that  is  capable  of  destroying  infec- 
tive materials  or  of  rendering  them  inert.  Chemical  sub- 
stances which  in  certain  definite  proportions  kill  bacteria 
in  fluids,  and  when  present  in  smaller  amounts  prevent 
their  multiplication,  are  disinfectants.  When  present  in 
the  larger  amounts  they  act  as  germicides — that  is,  they 
kill  the  bacteria;  while  in  the  smaller  amounts  they  are 
simply  disinfectants,  because  they  render  the  bacteria 
incapable  of  multiplication.  The  term  disinfectant  is 
also  sometimes  applied  to  substances  which  destroy  bad 
odors.  This  is,  however,  an  improper  use  of  the  term 
disinfectant.  These  substances  which  destroy  bad  odors 
are  deodorants,  and  may  or  may  not  be  disinfectants. 
Substances  which  retard  or  prevent  the  growth  of  bacteria 
are  usually  spoken  of  as  antiseptics,  because  they  prevent 
the  growth  of  the  septic  bacteria  as  well  as  others.  These 
antiseptic  substances,  in  larger  amounts,  generally  are 
germicides. 

A  reliable  disinfecting  agent  is,  therefore,  one  that  is 
germicidal  in  its  action.  A  good  disinfectant  should, 
however,  be  as  free  as  possible  from  poisonous  action 
upon  those  who  use  it,  and,  at  the  same  time,  it  should 
not   be  destructive    to    the    articles    to   be  disinfected. 

372 


DISINFECTANTS  IN  COMMON  USE.  373 

The  latter  quality  is  a  most  important  one  from  the  fact 
that  a  number  of  very  useful  disinfecting  agents  have  an 
injurious  or  even  destructive  action  upon  the  articles  to 
be  disinfected.  For  this  reason  dry  heat  is  not  applicable 
to  the  disinfection  of  fabrics,  because  the  degree  of  heat 
required  to  disinfect  thoroughly  would  be  sufficient  to 
char  them.  Articles  of  clothing  containing  blood  or 
other  stains  should  not  be  disinfected  by  means  of  hot 
water  or  steam,  because  these  agents  fix  the  stains  so  that 
they  remain  permanent.  Many  of  the  other  disinfecting 
agents  have  a  corrosive  action  upon  metals,  and  are, 
therefore,  not  adapted  for  the  disinfection  of  metallic 
articles.  Consequently  it  is  necessary  to  select  that  dis- 
infecting agent  which  is  least  likely  to  prove  objection- 
able. Fortunately  we  have  a  rather  wide  range  of  sub- 
stances and  agencies  to  select  from  according  to  the 
nature  of  the  articles  to  be  disinfected. 

The  disinfecting  agent  should  be  cheap,  in  order  to 
lessen  the  expense  as  much  as  possible.  Here  again  it  is 
possible  to  select,  for  certain  purposes,  agents  that  are 
comparatively  cheap  and  yet  quite  efficient.  Under 
other  circumstances  it  is  not  possible  to  avail  ourselves 
of  the  cheapest  agents,  because  they  are  not  suitable  for 
other  reasons.  For  instance,  milk  of  lime  is  a  most 
excellent  disinfectant  for  rough  work,  but  it  would  not 
be  applicable  under  all  conditions. 

All  our  present  knowledge  of  the  value  and  efficiency 
of  the  different  disinfecting  agents  is  based  upon  labora- 
tory experiments,  and  it  is  only  since  the  evolution  of 
modern  bacteriology  and  the  perfection  of  bacteriologic 
methods  that  it  was  possible  to  give  intelligent  direction 
to  our  efforts  toward  the  limitation  and  eradication  of 
disease  by  such  means. 

Disinfectants  in  Common  Use. — The  disinfectants  in 
common  use  are  of  two  classes,  heat  and  chemical  sub- 
stances. Heat  may  be  employed  as  a  disinfectant  in 
several  different  ways — as  dry  heat,  1500  to  1750  C. ,  for 
one  to  two  hours:  or  as  moist  heat,  as  steam  or  boilino- 


374  DISINFECTION. 

water.  The  principal  chemical  disinfectants  are  formal- 
dehyd  gas  and  solution,  mercuric  chlorid  solution,  car- 
bolic acid  solution,  trikresol,  chlorid  of  lime  and  caustic 
lime,  sulphur  dioxid,  zinc  chlorid,  and  copper  sulphate. 
Fire  is  also  a  most  efficient  disinfectant,  but  is  applicable 
only  for  substances  that  are  not  combustible,  or  for  com- 
bustible substances  that  are  of  little  or  no  value.  Sun- 
light is  also  an  efficient  disinfectant.  This  agent  is  con- 
stantly acting  and,  no  doubt,  removes  most  of  the  detri- 
mental agents  on  surfaces  exposed  to  the  sun.  Most 
bacteria  grow  best  in  the  dark.  Many  species  fail  to 
grow  at  all  in  diffuse  daylight,  while  direct  sunlight  is 
injurious  to  all  species. 

Disinfection  on  I^arge  Scale. — Disinfection  on  a 
large  scale,  for  infected  clothing  and  bedding,  is  usually 
accomplished  by  means  of  steam  under  pressure.  A 
special  form  of  apparatus  is  required  for  this  purpose 
(see  Fig.  58).  A  special  building  should  be  constructed 
for  a  municipal  disinfecting  plant.  The  disinfecting 
chamber  should  be  so  arranged  that  the  infected  clothing 
is  brought  into  one  room,  where  it  is  introduced  into  the 
disinfecting  chamber.  After  it  has  been  disinfected,  it  is 
taken  out  of  the  chamber  from  the  other  side  of  a  parti- 
tion wall  and  stored  in  a  room  that  has  no  connection 
with  the  first  room  except  through  the  disinfecting 
chamber.  The  doors  of  the  disinfecting  chamber  should 
be  so  arranged  that  only  one  can  be  opened  at  a  time,  so 
as  to  prevent  infectious  materials  from  being  carried  over 
into  the  room  containing  the  disinfected  clothing.  The 
attendants  handling  the  infected  clothing  should  not 
come  in  contact  with  those  who  handle  the  disinfected 
clothing.  The  disinfected  clothing  should  never  be  re- 
turned in  the  same  conveyance  used  for  the  collection  of 
infected  clothing. 

The  disinfecting  power  of  steam  is  dependent  upon 
the  extent  of  the  pressure  to  which  it  is  subjected, 
the  greater  the  pressure  the  higher  its  disinfecting 
power,  because  the  temperature  of  the  steam  increases 


DISINFECTION  ON  LARGE  SCALE. 


375 


with  the  increased  pressure.  The  steam  given  off 
from  boiling  water  in  an  open  vessel  has  the  same 
temperature  as  that  of  the  water — ioo°  C.  At  one 
additional  atmosphere  pressure  we  obtain  a  temperature 
of  121. 50  C ;  at  two  atmospheres,  1350  C. ;  at  three  atmos- 
pheres, 1450  C. ;  at  four  atmospheres,  153. 3°C. ;  and  at 
five  atmospheres,  1600  C.     A  pressure  of  one  atmosphere 


Steam  disinfecting  plant. 


is  equal  to  1  kilogram  per  square  centimeter  of  surface. 
Spores  are  not  destroyed  when  heated  to  the  temperature 
of  boiling  water,  but  at  a  pressure  of  two  to  three  addi- 
tional atmospheres  disinfection  by  steam  kills  spores 
almost  immediately.  All  pathogenic  bacteria  in  the 
vegetative  stage  are  killed  when  heated  to  from  650  to 
750  C,  so  that  the  temperature  of  boiling  water  is  suf- 
ficient to  kill  a  large  number  of  the  different  species  of 
pathogenic  bacteria — the  non-spore-bearing  forms.   When 


3?6  DISINFECTION. 

infected  clothing  and  bedding  are  to  be  disinfected  by- 
means  of  steam,  it  is  necessary  to  use  steam  under  press- 
ure to  cause  the  heat  to  penetrate  into  the  interior  of  the 
bundles  to  be  disinfected. 

Formaldehyd. — Of  the  different  chemical  disinfect- 
ants, formaldehyd  is  now  considered  the  most  efficient, 
and  is  in  general  use  for  the  purpose  of  room  disinfection. 
The  disinfectant  action  of  formaldehyd  was  discovered  in 
1886  by  O.  Loew.  The  formaldehyd  gas,  as  generally 
employed  for  purposes  of  disinfection,  has  no  great  pene- 
trating powers,  and  it  cannot,  therefore,  be  relied  upon  for 
the  disinfection  of  bundles  of  clothing  and  bedding.  For 
the  disinfection  of  such  articles  the  gas  must  be  applied 
under  pressure  by  means  of  a  vacuum  chamber.  This 
disinfectant  is  most  commonly  used  for  the  disinfection 
of  rooms  in  which  there  have  been  cases  of  infectious 
diseases.  It  is  entirely  harmless  for  all  classes  of  house- 
hold goods.  Upon  the  removal  of  the  patient  the  room 
is  closed  as  tightly  as  possible,  and  all  cracks  are  closed 
by  means  of  gummed  paper;  all  the  bedding  and  clothing 
are  spread  out,  the  drawers,  doors  of  cupboards,  and 
closets  are  opened,  and  the  gas  is  introduced  through  the 
keyhole  of  the  door.  The  gas  is  generated  in  a  special 
apparatus  outside  the  room,  either  from  an  aqueous  solu- 
tion of  the  gas  by  the  application  of  heat,  by  the  oxida- 
tion of  wood  alcohol,  or  by  the  volatilization  of  paraform 
by  means  of  heat. 

Generation  of  Formaldehyd  Gas. — An  excellent 
form  of  formaldehyd  gas  regenerator  is  that  manu- 
factured by  Lentz  &  Sons,  of  Philadelphia  (Fig.  59), 
which  consists  of  a  stout  copper  retort  of  about  2\  liters 
(4  pints)  capacity,  with  funnel  filling  tube  and  level 
indicator,  a  stopper  of  special  construction,  and  inclined 
brass  outlet  tube  of  large  bore,  connected  by  means  of  a 
flexible  tube  with  another  and  smaller  brass  tube,  which  is 
inserted  through  the  keyhole  of  the  room  to  be  disinfected. 

The  solution  in  the  retort  is  heated  by  means  of  a 
special  form  of  "Primus"  lamp,  D,  which  burns  kero- 


FORMALDEHYD. 


377 


sene  and  develops  a  temperature  of  11500  C.  (21000  F.). 
The  solution  is  introduced  into  the  bottom  of  the  retort 
through  the  small  funnel  at  the  top,  and  the  stopcock  A 
on  the  connection  is  allowed  to  remain  open,  so  that  ex- 
haustion of  the  solution  is  at  once  detected  by  the  escape 
of  gas.  The  cap  of  the  retort  is  held  in  position  by 
means  of  a  strong  iron  yoke,  provided  with  a  clamping 


Fig.  59. — Formaldehyd  gas 
.  regenerator. 


Fig.  60. — Formaldehyd  gas 
regenerator. 


screw,  B.  When  the  supply  of  solution  in  the  retort  is 
exhausted  the  flame  is  at  once  extinguished  by  turning 
the  thumb-screw  F  to  the  left.  If  it  is  desired  to  con- 
tinue the  disinfection,  a  filled  retort  can  be  substituted 
for  the  exhausted  one  by  turning  the  screw  C,  which 
holds  the  retort  in  place.  The  heat  of  the  flame  is  per- 
fectly under  the  control  of  the  operator.     It  can   be  in- 


378  DISINFECTION. 

creased  by  means  of  the  pump  G,  or  decreased  by  means 
of  the  valve. 

The  efficiency  of  this  apparatus  is  attested  by  the  fact 
that  the  United  States  War  Department  has  over  one 
hundred  of  them  in  use,  besides  large  numbers  in  use 
by  boards  of  health  in  many  of  the  larger  cities,  by  hos- 
pitals, schools,  and  physicians. 

Fig.  60  represents  the  Trenner  formaldehyd  regenera- 
tor, for  which  certain  important  advantages  are  claimed. 
It  is  so  constructed  as  to  permit  its  use  either  within  the 
room  to  be  disinfected  or  outside  the  room.  The  intro- 
duction of  copper  plates  in  the  interior  of  the  retort 
serves  to  prevent  the  frothing  of  the  boiling  fluid,  and 
hence  prevents  the  projection  of  fluid  from  the  apparatus. 
The  use  of  a  large  alcohol  burner  makes  it  possible  to 
generate  the  gas  very  quickly,  rapidly,  and  uniformly, 
and  the  amount  of  alcohol  in  the  burner  can  be  so  regu- 
lated as  to  become  exhausted  and  extinguish  the  flame 
when  all  the  solution  has  been  utilized.  This  is  an  im- 
portant advantage  when  the  apparatus  is  to  be  placed  in 
the  room  to  be  disinfected. 

The  formaldehyd  gas  acts  most  efficiently  when  moist 
and  at  a  high  temperature.  To  meet  these  conditions 
the  gas  is  either  mixed  with  steam  or  it  is  generated  from 
a  mixture  of  formaldehyd  solution  and  glycerin.  The 
glycerin  prevents  the  gas  from  polymerizing  as  readily 
as  when 'in  the  dry  state.  The  moisture  may  be  sup- 
plied also  by  spraying  all  the  surfaces  of  the  room,  as 
well  as  all  articles  contained  in  it,  with  a  solution  of 
formaldehyd  before  beginning  the  disinfection,  or  by 
suspending  sheets,  saturated  with  formaldehyd,  in  the 
room.  It  is  entirely  harmless  in  its  action  upon  fabrics, 
and  is  not  highly  poisonous,  though  it  has  an  irritant 
action  upon  the  mucous  membrane  when  respired.1     The 

1  Disinfection  by  means  of  formaldehyd  has  been  rendered  quite  safe,  with 
regard  to  danger  from  fire,  since  the  modern  apparatuses  permit  the  evolution 
of  the  gas  outside  the  room  to  be  disinfected,  the  gas  being  conducted  into  the 
room  through  the  key-hole. 


SULPHUR  DIOXID.  379 

formic  aldehyd  solution  contains  about  40  per  cent,  of 
the  gas,  and  is  relatively  cheap.  It  can  be  purchased 
everywhere  in  this  form,  and  is  also  sold,  at  a  much 
higher  price,  under  the  trade  name  of  ' '  formalin. ' '  From 
500  to  600  cubic  centimeters  of  the  glycerin-formaldehyd 
mixture  (1  :  50)  are  usually  employed  to  disinfect  a  space 
of  from  25  to  30  cubic  meters.  A  liter  of  wood  alcohol 
will  yield  748  grams  =  361  liters  of  aldehyd.  This 
amount  of  gas  in  a  room  of  25  to  30  cubic  meters  would 
give  1.25  to  1.5  per  cent,  of  aldehyd  in  the  air  of  the 
room.  Stiiver  concludes  that  a  closed  room  must  con- 
tain 2.5  grams  of  formaldehyd  per  cubic  meter  of  space. 
1.6  grams  per  cubic  meter  kills  all  organisms  not  in  the 
spore  stage.  The  room  should  remain  closed  for  six 
hours  after  the  gas  has  been  generated. 

Sulphur  Dioxid. — Sulphur  dioxid  was  formerly  em- 
ployed to  a  large  extent  for  the  purposes  for  which  for- 
maldehyd is  now  employed.  The  gas  is  generated  by 
burning  ordinary  sulphur  in  the  room  to  be  disinfected. 
All  the  crevices  and  cracks  in  the  room  should  be  closed 
as  carefully  as  possible,  so  as  to  retain  the  gas  in  as  large 
volume  as  possible  within  the  room.  It  should  form 
from  4  to  10  per  cent,  of  the  volume  of  the  air  of  the 
room,  and  should  be  allowed  to  act  from  twelve  to 
twenty-four  hours.  To  generate  this  amount  of  the  gas, 
it  is  necessary  to  burn  about  \\  kilograms  of  sulphur  for 
each  25-30  cubic  meters  of  space.  This  gas  also  acts 
most  efficiently  in  a  moist  state — in  fact,  it  is  of  small 
penetrating  power  in  the  dry  state.  The  moisture  may 
be  generated  by  spraying  the  articles  in  the  room  or  by 
introducing  steam  during  the  time  the  gas  is  being  gen- 
erated. 

Hydrocyanic  Acid. — Recently  the  use  of  hydrocyanic 
acid  has  been  advocated  for  the  disinfection  of  rooms'. 
Aside  from  its  value  in  the  destruction  of  pathogenic  bac- 
teria, this  gas  possesses  the  additional  value  of  being  par- 
ticularly efficacious  in  the  destruction  of  vermin.  Con- 
trary to  the  generally  accepted  opinion,  this  gas  is  claimed 


380  DISINFECTION. 

to  be  far  less  dangerous  to  those  employing  it  than  was 
formerly  supposed  to  be  the  case. 

Corrosive  Sublimate. — For  a  long  time  corrosive  sub- 
limate had  been  regarded  as  the  most  reliable  and  efficient 
disinfecting  substance,  on  account  of  its  high  germicidal 
powers,  but  it  is  less  highly  esteemed  at  the  present  time, 
because  it  has  been  found  to  have  certain  very  important 
limitations.  It  is  a  most  highly  poisonous  substance,  and 
is  therefore  not  safe  for  general  use.  It  is  also  objection- 
able from  the  fact  that  it  is  precipitated  by  means  of 
albuminous  substances,  and  consequently  it  should  not  be 
employed  in  the  presence  of  such  substances.  The  addi- 
tion of  acids  prevents  the  destruction,  to  some  extent,  of 
the  corrosive  sublimate  through  combination  with  albu- 
minous substances.  Tartaric  or  sulphuric  acid  is  best 
adapted  for  this  purpose.  Because  of  its  poisonous  effects, 
it  is  customary  to  add  one  of  the  anilin  dyes  to  give  it  a 
distinctive  color  and  thus  limit  the  danger  of  accidental 
poisoning.  It  is  capable  of  fixing  permanently  any  stains 
on  clothing,  and  is,  in  consequence,  not  adapted  for  use 
with  such  materials.  It  kills  all  bacteria  and  their  spores 
in  a  few  minutes  in  1  :  1000  solution,  and  in  a  few  hours 
in  1 :  5000  solution.  The  mercury  unites  with  the  proto- 
plasm of  the  organisms  and  forms  albuminate  of  mercury, 
and  thus  kills  them. 

Carbolic  Acid. — This  is  a  very  active  germicide,  and  is 
therefore  an  efficient  disinfectant.  It  is  sparingly  soluble 
in  water,  the  extreme  being  about  5  per  cent,  in  saturated 
solution.  A  solution  of  this  strength  kills  bacteria  in  the 
vegetative  stage  in  less  than  a  minute.  Like  corrosive 
sublimate,  carbolic  acid  is  also  rendered  less  effective  by 
the  presence  of  albuminous  substances  in  the  material  to 
be  disinfected.  The  addition  of  sulphuric  acid  increases 
its  action,  and  for  the  roughest  work  a  mixture  of  equal 
parts  of  crude  carbolic  acid  and  commercial  sulphuric 
acid  is  most  serviceable.  This  mixture  is  employed  in  2 
to  3  per  cent,  solution.  Another  mode  of  employment  is 
in  the  form  of  carbol  soap.     This  mixture   is  of  great 


PRE  PARA  TIONS  OF  L  TME.  381 

value  in  the  disinfection  of  soiled  clothing  and  bedding, 
inasmuch  as  it  does  not  fix  the  stains,  and  yet  disinfects 
them  efficiently. 

Trikresol. — The  cresols  are  most  efficient  disinfectants, 
and  are  contained  in  considerable  quantities  in  crude 
carbolic  acid.  Trikresol  is  a  mixture  of  the  three  cresols, 
para-,  meta-,  and  ortho-cresol,  in  the  following  propor- 
tions: Para-cresol,  25  per  cent. ;  meta-cresol,  40  per  cent. ; 
ortho-cresol,  35  per  cent.  This  mixture  is  soluble  in 
water  in  the  proportion  of  2  to  5  per  cent.  It  is  poison- 
ous, and  its  action  is  also  increased  by  the  addition  of 
sulphuric  acid. 

Creolin. — This  substance  has  a  high  disinfectant  value. 
It  is  insoluble  in  water,  but  is  employed  as  an  emulsion 
in  water  in  the  proportion  of  2  to  5  per  cent.  It  is  used 
for  rougher  work,  as  around  kennels,  stables,  and  cellars. 

Nitrate  of  Silver. — The  use  of  this  substance  is  limited 
by  its  cost,  its  poisonous  qualities,  and  the  facility  with 
which  it  is  precipitated  by  albuminous  substances.  It 
appears,  however,  to  possess  special  value  as  a  disinfec- 
tant of  the  throat  in  convalescent  cases  of  diphtheria. 
The  application  of  a  20  per  cent,  solution  of  nitrate  of 
silver  to  the  throat,  as  recommended  by  Dr.  Hand,  serves 
to  render  it  free  from  diphtheria  bacilli  in  about  seven 
days,  while  the  average  length  of  time  that  they  persist 
in  throats  treated  by  other  methods  is  about  twenty-eight 
days. 

Preparations  of  I4me. — Chlorinated  Lime — This  is 
one  of  the  most  serviceable  disinfectants  known  at  the  pres- 
ent time  on  account  of  its  cheapness  and  because  it  is  not 
so  highly  poisonous  as  many  of  the  other  disinfectants  in 
use.  It  should  contain  at  least  25  per  cent,  of  available 
chlorin  as  hypochlorite.  In  o.  5  to  1  per  cent,  watery  solu- 
tion it  kills  typhoid  and  cholera  organisms  in  ten  min- 
utes. It  is  especially  adapted  for  the  disinfection  of 
typhoid  stools  and  for  use  in  the  disinfection  of  school- 
rooms and  school  furniture.  The  odor  of  chlorinated 
lime  may  be  readily  removed  by  exposing  cloths  satu- 


382  DISINFECTION. 

rated  with  a  solution  of  washing  soda  in  the  room  where 
lime  has  been  used. 

Milk  of  Lime,  or  whitewash,  is  also  a  serviceable  disin- 
fectant, and  is  usually  employed  in  the  disinfection  of 
cesspools  and  privy-vaults.  It  is  a  most  efficient  deodo- 
rant, and  in  this  respect  it  serves  a  double  purpose  when 
applied  to  walls  of  cellars,  etc. 

Washing"  Soda. — This  is  a  serviceable  disinfectant,  and 
no  doubt  serves  a  good  purpose  when  applied  to  floors  in 
the  ordinary  cleansing  operations.  In  2  per  cent,  solu- 
tion it  is  an  efficient  disinfectant  for  instruments  when 
boiled  in  it  for  ten  minutes. 

Sulphate  of  Iron. — For  rougher  work,  as  privy- 
vaults,  cesspools,  etc.,  this  substance  is  most  frequentty 
employed.  It  is  not  a  strong  disinfectant,  but  it  is  ser- 
viceable as  a  deodorant.  It  should  be  used  in  the  pro- 
portion of  1  kilogram  (dissolved  in  10  liters  of  water)  to 
a  cubic  meter  of  the  contents  of  the  vault. 

Physical  Agents. — The  principal  physical  agents 
employed  for  purposes  of  disinfection  are  dry  and  moist 
heat,  fire,  and  sunlight. 

Dry  Heat. — This  agent  is  not  employed  in  ordinary 
disinfection.  Its  use  is  confined  to  the  laboratory,  where 
it  is  employed  in  the  disinfection  of  glassware,  etc. 

Moist  Heat — The  use  of  moist  heat  is  almost  univer- 
sal, and  has  many  advantages  over  chemical  disinfect- 
ants. It  is  entirely  safe  and  very  efficient,  besides  being 
cheap,  so  that  it  has  all  the  requisites.  It  may  be 
employed  in  the  form  of  boiling  water  or  in  the  form  of 
steam.  Boiling  water  added  in  double  quantity  to  typhoid 
or  cholera  stools  disinfects  them  in  an  hour.  It  kills  the 
diphtheria  bacillus  in  five  minutes,  and  the  tubercle 
bacillus  in  ten  minutes,  and  consequently  it  is  most  ser- 
viceable for  the  disinfection  of  napkins  soiled  with  the 
discharges  of  diphtheria  or  tubercular  patients. 

Steam  is  now  used  largely  in  the  disinfection  of 
clothing  and  bedding,  such  as  mattresses  and  pillows, 
which  cannot  be  disinfected  bv  means  of  hot  water.     A 


DISINFECTION  OF  EXCRETA.  383 

special  apparatus  is  required  for  the  larger  pieces  which 
boards  of  health  are  obliged  to  deal  with.1  In  the  sick- 
room an  ordinary  potato-steamer  or  the  ordinary  milk- 
sterilizing  apparatus  may  be  employed. 

Fire,  of  course,  is  the  best  of  all  disinfectants,  because 
it  is  positive  in  its  action.  It  can,  however,  be  employed 
only  in  the  destruction  of  infected  articles  that  are  of 
little  or  no  further  use.  It  is  frequently  best  to  resort  to 
the  use  of  this  efficient  disinfecting  agent,  even  if  the 
infected  articles  are  of  slight  value,  because  we  are  then 
certain  no  danger  can  result  therefrom. 

Sunlight — The  direct  action  of  the  sun's  rays  kills 
non-spore-bearing  organisms  in  half  an  hour.  It  has, 
however,  but  little  penetrating  power,  and  consequently 
it  is  of  limited  applicability.  The  combined  influence 
of  sunlight  and  drying  as  a  purifying  agent  should  not 
be  altogether  ignored,  but  should  not  be  relied  upon 
exclusively. 

Disinfection  of  Infective  Materials. — The  chem- 
ical disinfectants  are  used  principally  by  direct  applica- 
tion to  infected  materials.  Mercuric  chlorid  is  used  in 
solutions  of  1  :  500  to  1  :  4000  strength.  Carbolic  acid  is 
used  in  2  to  5  per  cent,  solutions.  Chlorid  of  lime  is 
employed  in  0.5  to  1  per  cent,  solution,  prepared  from  a 
preparation  having  from  25  to  30  per  cent,  of  available 
chlorin. 

Disinfection  of  Hxcreta. — For  the  disinfection  of 
excreta  solutions  of  carbolic  acid  and  chlorid  of  lime 
are  usually  employed.  The  excreta  should  be  well  mixed 
with  equal  quantities  of  the  disinfectant  solution,  and 
allowed,  to  stand  for  several  hours  before  they  are  finally 
disposed  of.     Milk  of  lime,  or  caustic  lime,  may  also  be^ 

1  In  these  large  steam  disinfecting  apparatuses  the  air  can  be  exhausted  and 
the  steam  retained  under  pressure.  With  increase  in  pressure  there  is  an  in- 
crease in  temperature,  and  consequently  an  increase  in  the  effectiveness  of  the 
operation.  At  760  mm.  barometric  pressure  water  is  turned  into  steam  at 
ioo°  C.  (2I2°F.).  At  a  pressure  of  one  additional  atmosphere  we  obtain  a 
temperature  of  I2I.5°C.  (25o°F.1.  At  a  pressure  of  two  additional  atmos- 
pheres we  obtain  a  temperature  of  1350  C.  (2750  F.). 


384  DISINFECTION. 

used  for  this  purpose.  Mercuric  chlorid  solution  is  not 
adapted  for  the  disinfection  of  excreta,  because  the 
albuminous  material  present  combines  with  the  mercury 
to  form  insoluble  albuminate  of  mercury,  which  is  inert. 
Mercuric  chlorid  is  not  adapted  for  the  disinfection  of 
clothing  and  bedding,  because  it  fixes  any  stains  that 
may  be  present,  and  thus  prevents  their  subsequent  re- 
moval. 

In  order  to  obviate  the  destruction  of  the  disinfectant 
properties  of  mercuric  chlorid  through  the  agency  of 
albuminoid  materials,  acids  maybe  added  to  the  solution. 
In  France  the  following  mixture  is  employed  : 

Mercuric  chlorid 2  grams. 

Tartaric  acid 24       " 

Water      1000       " 

A  few  drops  of  a  5  per  cent,   solution  of  carminate  of 
indigo  are  added  to  give  the  solution  a  distinctive  color. 
In  England  the  following  mixture  is  employed  : 

Mercuric  chlorid I  ounce. 

Hydrochloric  acid io  ounces. 

Water      I  gallon. 

This  solution  is  colored  with  anilin  blue. 

Disinfection  of  the  Sick-room. — The  disinfection 
of  the  sick-room  during  the  time  it  is  occupied  by  the 
patient  is  essential  to  prevent  the  spread  of  infectious 
diseases.  The  prophylactic  measures  necessary  are  de- 
pendent upon  the  nature  of  the  disease,  though,  in  a 
general  way,  they  may  be  summarized  under  three  divi- 
sions: First,  those  applicable  to  the  exanthemata;  second, 
those  applicable  to  diseases  of  the  respiratory  apparatus; 
and  third,  those  applicable  to  diseases  of  the  gastro- 
intestinal tract.  The  principal  diseases  falling  within 
the  first  group  are  small-pox,  measles,  and  scarlet  fever; 
those  of  the  second  group  are  diphtheria,  pneumonia, 
and  tuberculosis;  and  those  of  the  third  group  are  cholera,, 
dysentery,  and  typhoid  fever. 


DISINFECTION  OF  THE  SICK-ROOM.  385 

In  the  Exanthemata. — In  the  first  group  of  diseases 
the  infectious  material,  whatever  its  nature,  seems  to  be 
thrown  off  principally  from  the  skin.  It  is  most  essen- 
tial, therefore,  to  prevent  the  emanations  from  the  skin 
gaining-  access  to  the  air  of  the  room.  This  is  best 
accomplished  by  daily  anointing  the  patient's  body  with 
some  bland  oil.  The  bed-clothing  is  to  be  removed  with 
as  little  agitation  as  possible,  and  at  once  placed  in  a  tub 
of  water  or  a  weak  antiseptic  solution  before  it  is  removed 
from  the  room.  The  floor,  walls,  furniture,  and  all 
horizontal  surfaces  in  the  room  should  be  wiped  daily 
with  a  damp  cloth.  The  cloth  may  be  dampened  with  a 
2  per  cent,  solution  of  carbolic  acid  to  increase  the 
efficiency  of  the  cleansing  operation.  There  should  be 
abundant  ventilation  of  the  room,  and  the  most  scrupu- 
lous cleanliness.  As  soon  as  any  article  of  clothing  or 
bedding  is  soiled,  it  should  be  removed  in  the  manner 
described.  The  sick-room  must  be  rigidly  isolated  from 
the  remainder  of  the  house,  and  the  family  must  be  ex- 
cluded from  it. 

In  the  Respiratory  Diseases. — In  the  diseases  of  the 
second  group  the  infectious  material  is  contained  in  the 
secretions  of  the  nose  and  throat  and  in  the  expectora- 
tions. The  most  rigid  care  must,  therefore,  be  exercised 
in  the  collection  and  removal  of  this  material.  Great  care 
must  be  taken  to  prevent  the  patient  from  infecting  his 
hands  and  person,  and  thus  everything  with  which  he 
comes  in  contact.  The  sputum  should  be  collected  in  a 
special  receptacle  containing  a  disinfectant  solution  ; 
this  receptacle  must  be  removed  once  or  twice  daily, 
emptied,  and  disinfected.  The  patient's  hands  must  be 
disinfected  frequently  with  a  solution  of  chlorid  of  lime 
or  of  carbolic  acid.  The  nurse  also  should  disinfect  her 
hands  after  each  handling  of  the  patient.  The  clothing 
and  bedding  must  be  removed  as  soon  as  soiled,  in  the 
manner  described  under  the  first  group  of  infectious  dis- 
eases. The  room  must  also  be  disinfected  in  the  manner 
already  described.     The  table  utensils  used  in  feeding 

25 


386  DISINFECTION. 

the  patient  should  be  disinfected  before  they  are  mixed 
with  those  in  use  by  the  family.  All  food  not  eaten  by 
the  patient  should  be  destroyed. 

In  the  Intestinal  Diseases. — In  the  third  group  of  dis- 
eases the  infectious  material  is  contained  in  the  urine 
and  feces  and  in  the  vomit.  All  these  excreta  must  be 
disinfected  by  means  of  equal  quantities  of  chlorid  of 
lime  solution  or  5  per  cent,  carbolic  acid  solution.  Special 
care  is  necessary  in  the  care  of  the  patient's  hands  and 
person.  Daily  disinfection  of  the  body  of  the  patient  is 
necessary  whenever  the  evacuations  are  frequent  and  not 
carefully  collected  and  removed.  All  soiled  clothing  and 
bedding  must  be  removed  and  disinfected.  The  nurse's 
hands  should  be  disinfected  after  handling  the  patient. 

In  the  intestinal  diseases  special  attention  should  be 
given  to  the  purity  of  the  water-supply.  All  the  water 
used  for  drinking-purposes  should  be  boiled  whenever  it 
is  believed  to  be  the  source  of  the  infection.  This  applies 
not  only  to  the  water  used  by  the  patient,  as  is  sometimes 
directed,  but  to  all  the  water  used  by  the  household  or 
community  using  the  water  for  domestic  purposes. 

When  these  prophylactic  measures  are  carefully  fol- 
lowed, the  air  of  the  room  should  be  practically  free  from 
infective  dust.  This  is  the  principal  danger  in  all  the 
infectious  diseases,  aside  from  direct  contact  with  the 
patient,  his  clothing,  or  the  excreta.  There  is  no  danger 
of  contracting  any  of  the  infectious  diseases  from  the 
breath  of  the  patient.  None  of  the  specific  pathogenic 
organisms  are  given  off  with  the  expired  air  in  ordinary 
quiet  respiration.  Bacteria  may  be  projected  from  the 
mucous  surfaces  of  the  mouth  and  nose  in  coughing, 
sneezing,  or  energetic  talking,  but  never  in  quiet  respira- 
tion. 

In  Other  Infectious  Diseases. — The  prophylactic  meas- 
ures necessary  in  the  other  infectious  diseases  will  be 
apparent  to  anyone  who  is  familiar  with  their  character 
and  the  excreta  with  which  the  infectious  material  leaves 
the   body.     Common    sense   will    teach    any    intelligent 


DISINFECTION  OF  HABITA  TIONS.  387 

person  to  apply  the  prophylactic  measures  in  the  right 
direction  if  these  factors  are  borne  in  mind. 

Disinfection  of  Habitations. —  After  recovery  or 
death  from  cholera,  small-pox,  relapsing,  typhoid,  typhus, 
and  scarlet  fevers,  diphtheria,  measles,  cerebrospinal 
meningitis,  and  severe  dysentery,  the  effects  and  rooms 
occupied  by  the  patient  during  sickness  should  be 
promptly  disinfected.  All  large  municipalities  have  a 
specially  trained  force  of  men  who  carry  out  the  details 
of  disinfection  of  habitations  before  the  placard  is  re- 
moved from  the  house. 

The  clothing  and  bedding  which  are  to  be  disinfected 
by  means  of  steam  should  be  carefully  wrapped  in  cloths 
saturated  with  1  per  cent,  carbolic  acid  solution,  placed 
in  a  wagon,  and  taken  to  the  disinfecting  station.  After 
the  bed  has  been  stripped,  all  refuse  matter,  paper,  and 
articles  of  little  value  are  wrapped  in  cloths  saturated 
with  carbolic  acid  and  burned  in  a  stove  or  furnace. 

The  floor,  doors,  windows,  furniture,  and  the  walls 
for  a  distance  of  4  meters  from  the  floor  should  be 
washed  with  5  per  cent,  carbolic  acid  solution.  The 
walls  and  ceiling  of  the  room  should  subsequently  be 
sprayed  with  1  :  1000  bichlorid  of  mercury  solution. 
If  the  walls  are  papered,  it  is  advisable  to  remove  care- 
fully the  paper  before  beginning  the  disinfection.  The 
room  is  then  closed  as  tightly  as  possible  and  disinfected 
by  means  of  formaldehyd. 

In  the  disinfection  of  habitations  after  diseases  of  the 
alimentary  type  the  hopper  of  each  water-closet  should 
be  disinfected  by  pouring  into  it  3  liters  of  chlorinated 
lime;  and  the  householder  or  landlord  should  be  instructed 
to  use  in  the  same  manner  1  liter  of  chlorinated  lime 
daily  for  several  days  afterward. 

The  vessels  in  which  the  excretions  of  the  patient 
(stools,  vomit,  sputum)  had  been  collected  should  be 
washed  with  5  per  cent,  carbolic  acid  solution,  and  then 
filled  with  the  same  solution  and  allowed  to  stand  for 
twenty-four  hours  before  they  are  emptied. 


388  DISINFECTION. 

Disinfection  of  the  Patient. — After  convalescence 
has  been  established  the  question  arises,  How  soon  may 
the  patient  mingle  with  the  remainder  of  the  family 
without  danger  of  carrying  the  infection?  It  is  quite 
evident  that  this  period  of  time  will  vary  not  only  with 
different  diseases  but  also  in  the  same  disease.  This  is 
manifest  when  we  take  pains  to  determine  the  length  of 
time  during  which  virulent  diphtheria  bacilli  persist  in 
the  throat  after  all  symptoms  have  subsided.  This  has 
extended  over  a  period  of  three  months  or  more  in  some 
cases,  the  average  being  about  four  weeks. 

In  the  exanthemata  it  is  customary  to  raise  the  quar- 
antine when  the  physician  reports  the  recovery  of  the 
patient,  but  the  child  is  not  allowed  to  attend  school  for 
thirty  days  afterward.  As  long  as  we  do  not  know  defi- 
nitely the  cause  of  the  exanthemata,  it  is  safest  to  fix  some 
arbitrary  time  during  which  these  patients  must  still  be 
regarded  as  dangerous  to  the  well. 

In  diphtheria  it  is  possible  to  determine  when  the 
patient  is  free  from  the  infectious  agents  by  bacteriologic 
means.  As  soon  as  the  throat,  nose,  and.  the  accessory 
cavities  are  free  from  diphtheria  bacilli,  the  patient  may 
safely  mingle  with  the  well.  Unfortunately,  in  the  ex- 
anthemata we  are  unable  to  apply  any  such  practical 
test.  The  only  test  we  possess  is  completion  of  desqua- 
mation. 

In  typhoid  fever  it  has  been  found  that  the  bacilli  per- 
sist in  the  urine  for  a  considerable  time,  and  here  also  it 
is  possible  to  apply  the  cultural  test  to  determine  the 
time  when  the  patient  is  no  longer  a  menace  to  the  com- 
munity. 

When  the  patient  has  recovered  from  an  infectious 
disease,  he  should  be  given  a  general  bath  with  soap 
and  wTater.  In  addition  to  this,  he  may  be  bathed  with 
chlorinated  soda  solution,  and  in  the  exanthemata  it  may 
be  advisable  to  anoint  his  body  again  unless  all  desquama- 
tion has  ceased.  After  a  general  bath  has  been  given, 
the  patient  may  be  allowed  to  mingle  with  the  well. 


DISINFECTION  OF  HABITA  TIONS.  389 

In  most  localities  the  convalescent  from  certain  dis- 
eases, especially  small-pox,  is  washed  with  1  :  2000  bi- 
chlorid  of  mercury  solution,  clothed  with  clean  clothing, 
and  then  transferred  to  a  disinfected  room. 

The  State  Board  of  Health  of  Pennsylvania  has  given 
the  following  Instructions  for  Disinfecting : 

"To  Disinfect  Clothing,  Towels,  Napkins,  Bedding,  and 
such  other  Articles  as  can  be  Washed. — Use  standard 
solution  No.  4,  1  ounce  to  the  gallon  of  water,  or  use  1 
gallon  of  solution  No.  1  in  9  gallons  of  water.  Let  the 
goods  soak  in  the  solution  for  at  least  two  hours  before 
they  leave  the  room.  Stir  them  up  so  that  the  solution 
gets  all  through  them.  After  disinfection,  boil  the 
goods  thoroughly. 

"To  Disinfect  the  Room  after  it  is  Vacated. — If  it  is 
possible,  let  the  room  be  thrown  wide  open  for  several 
days,  for  a  thorough  airing.  If  papered,  let  the  paper  be 
all  removed  with  care;  then  let  the  walls,  the  floors,  and 
the  woodwork  of  the  room,  as  well  as  the  furniture,  be 
washed  with  standard  solution  No.  4,  1  pint  in  4  o-allons 
of  water,  or  of  solution  No.  1,  \  pint  to  1  gallon  of  water. 
Let  this  work  be  done  most  carefully,  getting  the  solu- 
tion into  all  the  crevices;  wipe  it  out  with  a  rag  wet  in 
the  disinfecting  fluid.  Do  not  stir  it  up  with  a  brush  or 
broom.     Last  of  all,  whitewash  the  walls  and  ceiling-. 

"Some  articles  should  be  burned,  such  as  children's 
playthings  and  books  used  during  sickness,  articles  of  fur 
and  wool,  such  as  strips  of  carpet  and  pieces  of  badly 
infected  woollen  clothing.  In  a  city,  this  is  best  done 
by  making  them  up  into  a  compact  bundle  in  the  sick- 
room, thoroughly  dampening  the  outside  of  the  bundle 
with  a  solution  of  lime  or  corrosive  sublimate  in  water, 
and  then  carrying  it  to  the  glowing  furnace  under  a  large 
boiler  in  some  industrial  establishment.  If  in  the  coun- 
try, these  things  should  be  carried  into  a  field  or  woods 
far  from  any  human  habitation,  and  there  made  to  burn 
thoroughly  and  quickly,  to  do  which  the  bundle  should 
be  opened  and  saturated  with  petroleum.     Under  no  cir- 


390  DISINFECTION. 

cumstances  should  these  things  be  thrown  into  an  open 
space  or  lot,  or  into  running  water. 

«  Standard  Disinfecting  Solutions. — Standard  Solution 
No.  1. — Dissolve  chlorid  of  lime  or  bleaching-powder  of 
best  quality  (containing  at  least  25  per  cent,  of  available 
chlorin)  in  soft  water  in  the  proportion  of  6  ounces  to  the 
gallon. 

^Standard  Solution  No.  2. — Dissolve  corrosive  subli- 
mate and  permanganate  of  potassium  in  soft  water  in 
the  proportion  of  2  drams  of  each  salt  to  the  gallon 
of  water. 

"  Standard  Solution  No.  j. — To  1  part  of  Tabarraque's 
solution  of  hypochlorite  of  sodium  (liquor  sodse  chloratse, 
U.  S.  P.)  add  5  parts  of  soft  water. 

"  Standard  Solution  No.  4- — Dissolve  corrosive  subli- 
mate in  water  in  the  proportion  of  4  ounces  to  the  gallon, 
and  add  1  dram  of  permanganate  of  potassium  to  give 
color  to  the  solution  as  a  precaution  against  poisoning. 
One  fluidounce  of  this  to  the  gallon  of  water  is  sufficiently 
strong." 

Disinfection  of  Public  Conveyances. —The  danger 
of  disseminating  disease  through  public  conveyances  has 
led  to  a  great  deal  of  discussion,  and  in  many  communi- 
ties it  has  passed  beyond  the  stage  of  discussion.  Many 
local  and  State  boards  of  health  prohibit  the  promiscuous 
expectoration  in  public  places  which  was  once  so  com- 
mon. The  danger  of  disseminating  infectious  diseases 
by  allowing  sick  persons  to  be  conveyed  in  the  ordinary 
public  conveyances  has  led  to  the  appointment  of  a  com- 
mittee on  car  sanitation  by  the  American  Public  Health 
Association.  At  the  last  meeting  of  the  association  this 
committee  rendered  and  had  adopted  the  following  report: 

"  1.  When  a  passenger  is  known  to  be  contagiously 
ill,  he  should  be  isolated  in  a  compartment  appropriately 
equipped  and  ventilated  in  such  a  manner  as  to  separate 
it  from  the  rest  of  the  car.  Through  trains  should  be 
provided  with  rooms  for  the  sick  as  well  as  state-rooms, 
interchangeable  in  use. 


DISINFECTION  OF  PUBLIC  CONVEYANCES.     391 

"2.  The  interior  of  passenger  cars  should  be  plain, 
and  finished  with  hard,  smooth,  and  polished  sur- 
faces. 

"3.  All  furnishings  should  be  as  non-absorbent  as 
possible. 

' '  4.  Coaches  should  be  furnished  with  effective  means 
for  continuously  supplying  not  less  than  1000  cubic  feet 
of  warm  air  an  hour  for  each  single  seat,  and  for  dis- 
tributing and  removing  the  air  without  troublesome 
draught. 

"5.  The  temperature  should  be  regulated. 

"6.  The  cleaning  of  cars  should  be  frequent  and 
thorough. 

"7.  Floors  and  sanitary  lavatory  fixtures  should  be 
frequently  treated  with  a  disinfecting  wash. 

"  8.  All  fabrics  in  cars  should  receive  sterilizing  treat- 
ment. All  bed  and  lavatory  linen  should  be  thoroughly 
sterilized  in  the  process  of  laundering. 

' '  9.  Sewage-tanks  and  earth-closets  should  be  provided 
under  the  cars.  The  practice  of  disposing  of  excreta  by 
scattering  it  over  roadbeds  is  dangerous. 

"  10.  Water  and  ice  should  be  obtained  from  the  purest 
available  sources.  The  use  of  tongs  in  handlino-  ice 
should  be  insisted  upon. 

"11.  The  water-tank  should  be  frequently  cleansed 
and  periodically  sterilized  with  boiling  water  or  other- 
wise. 

"  12.  The  public  should  be  educated  to  use  individual 
cups.  Paper  paraffined  cups  might  be  provided  by  a 
cent-in-the-slot  device. 

"13.  The  use  of  canned  goods  in  buffet-car  service 
makes  careful  inspection  of  such  goods  imperative.  Fruits 
and  all  eatables  before  and  after  purchase  should  be  stored 
with  care,  to  avoid  all  unnecessary  exposure  to  street 
and  car  dust. 

"  14.  The  filthy  habit  of  spitting  on  car  floors  should 
be  dealt  with  in  a  manner  to  cause  its  prompt  discontinu- 
ance.    It  should  be  punished  as  one  of  the  most  flagrant 


39 2  DISINFECTION. 

of  the  thoughtless  offences  against   the  public  right  to 
health. 

"  15.  Station  premises  should  receive  attention  directed 
to  general  cleanliness  of  floors,  furnishings,  air,  sanita- 
ries,  lavatories,  platforms,  and  approaches,  and  should  be 
plentifully  supplied  with  approved  disinfecting  material. ' ' 


CHAPTER    XIX. 
QUARANTINE. 

Quarantine  applies  to  the  detention  of  ships  with 
cases  of  infectious  diseases  on  board  to  the  ports  in  which 
they  are  found,  to  the  detention  of  persons  in  infected 
localities,  and  to  the  detention  of  the  occupants  of  a 
house  in  which  there  is  a  case  of  infectious  disease.  The 
first  is  commonly  spoken  of-  as  maritime  quarantine,  the 
detention  of  persons  in  infected  localities  as  inland 
quarantine,  and  the  last  as  house  quarantine. 

Maritime  Quarantine. — Maritime  quarantine  consists 
of  the  detention  of  the  infected  ship,  the  isolation  of  the 
sick  in  a  special  hospital  at  the  quarantine  station,  the 
disinfection  of  the  ship  and  its  cargo  as  well  as  the  cloth- 
ing and  bedding  of  the  well,  the  detention  of  all  well 
persons  in  barracks  until  after  the  period  of  incubation 
of  the  particular  disease  has  elapsed  and  all  danger  of 
dissemination  has  been  eliminated.  The  period  of  deten- 
tion, the  mode  of  disinfection,  as  well  as  all  the  other 
prophylactic  measures  employed,  will  depend  entirely 
upon  the  character  of  the  disease,  its  period  of  incuba- 
tion, and  the  nature  of  the  ship's  cargo.  The  disin- 
fecting agents  commonly  employed  are  superheated 
steam  and  formaldehyd. 

The  national  government  maintains  quarantine  and 
inspection  stations  at  the  following  points:  Portland, 
Me. ;  Boston,  Mass. ;  New  York,  N.  Y. ;  Delaware  Break- 
water and  Reedy  Island,  Del. ;  Alexandria  and  Cape 
Charles,  Va. ;  Beaufort,  Cape  Fear,  Newbern,  and  Wash- 
ington, N.  C. ;  Brunswick,  Blackbeard  Island,  and 
Savannah,  Ga. ;  Tortugas  Islands,  Fla. ;  Pascagoula  and 
Ship  Island,  Miss. ;  San  Diego,  San  Pedro,   San   Fran- 

393 


394  QUARANTINE. 

cisco,  Los  Angeles,  and  Eureka,  Cal. ;  Columbia  River, 
Ore. ;  Port  Townsend,  Grays  Harbor,  and  Port  Angeles, 
Wash. ;  Dutch  Harbor  and  Nome,  Alaska. 

Some  of  the  States  and  municipalities  having  impor- 
tant seaports  have  also  established  quarantine  and  inspec- 
tion stations  in  addition  to  those  of  the  national  govern- 
ment, as  follows:  Bangor,  Me.;  Boston  and  New  Bed- 
ford, Mass. ;  Providence  and  Newport,  R.  I. ;  New  York, 
N.  Y. ;  Marcus  Hook,  Pa.;  Baltimore,  Md. ;  Newport 
News  and  Elizabeth  River,  Va. ;  Port  Royal,  St.  Helena 
Entrance,  and  Charleston,  S.  C. ;  Mayport,  Tampa  Bay, 
Pensacola,  Auclote,  Carrabelle,  Charlotte  Harbor,  Cedar 
Keys,  and  Key  West,  Fla. ;  Mobile  Bay,  Ala. ;  New 
Orleans,  La. ;  Galveston,  Quintana,  Sabine  Pass,  and 
Pass  Cavallo,  Tex. ;  and  Gardiner,  Ore. 

Inland  Quarantine. — Inland  quarantine  is  employed 
in  times  of  epidemics  confined  to  certain  localities  of  the 
country.  In  the  United  States  this  form  of  quarantine 
has  been  frequently  applied  to  localities  infected  with 
yellow  fever.  The  prevention  of  all  communication  with 
the  locality  is  sometimes  enforced  by  means  of  a  line  of 
guards  surrounding  the  locality,  and  hence  is  frequently 
spoken  of  as  "shotgun"  quarantine.  Where  important 
railroad  centers  are  involved  in  an  infected  area,  this 
form  of  quarantine  is  commonly  known  as  railroad  quar- 
antine, and  all  intercourse  with  the  infected  area  by  rail 
is  stopped.  All  merchandise  and  mail  coming  from  the 
infected  area  are  disinfected  whenever  traffic  is  not  com- 
pletely at  a  standstill. 

The  extension  of  inland  quarantine  to  interstate  com- 
merce and  traffic  is  known  as  interstate  quarantine,  and 
becomes  necessary  where  large  areas  are  infected  and 
there  is  danger  of  general  dissemination  of  the  infectious 
disease.  The  establishment  of  definite  interstate  quar- 
antine regulations  by  the  U.  S.  Treasury  department 
obviates  in  large  part  the  confusion  which  frequently 
existed  during  an  epidemic  of  yellow  fever,  because  of 
the  conflicting,  and  in  many  instances  ridiculous,  quar- 


VALUE  OF  DISINFECTION  AND  ISOLATION.  395 

antine  regulations  formulated  by  State,  county,  and 
municipal  authorities. 

Isolation  or  House  Quarantine. —  The  infectious 
diseases  against  which  house  quarantine  is  usually  em- 
ployed are  small-pox,  scarlet  fever,  diphtheria,  cerebro- 
spinal meningitis,  cholera,  typhus  and  typhoid  fevers, 
yellow  fever,  relapsing  fever,  and  leprosy.  Plague  is  now 
also  included  in  this  category. 

The  patient  suffering  from  any  of  these  infectious  dis- 
eases should  be  isolated  from  the  rest  of  the  family,  pref- 
erably in  a  room  on  an  upper  floor  of  the  house.  All 
persons  residing  in  the  house  are  prohibited  from  attend- 
ing any  school  whatsoever,  as  well  as  from  going  to  any 
other  places  of  public  assembly.  No  one  is  allowed  to 
enter  the  house  during  the  course  of  the  disease  except 
those  in  direct  charge  of  the  patient,  and  no  one  is  per- 
mitted to  visit  the  sick-room  except  the  physicians  and 
attendants.  The  house  is  placarded  by  the  local  health 
authorities  with  a  placard  indicating  the  nature  of  the 
disease  and  the  danger  of  communicating  the  disease  to 
others.  The  placard  is  not  removed  by  the  health 
authorities  until  after  the  patient  has  either  recovered 
or  died,  and  the  premises  have  been  thoroughly  disin- 
fected. 

Value  of  Disinfection  and  Isolation. — It  is  impos- 
sible to  give  definite  information  with  regard  to  the  value 
of  disinfection  alone,  because  at  the  present  time  it  is 
almost  always  practised  along  with  isolation.  The  value 
of  these  measures  in  such  a  disease  as  small-pox  is  well 
known.  In  other  diseases  they  are  no  doubt  of  equal 
value.  The  only  figures  obtainable  which  bear  directly 
upon  this  point  are  contained  in  the  reports  of  the  State 
Board  of  Health  of  Michigan.  In  the  report  for  the 
year  1898  are  given  some  comparative  observations  made 
during  a  number  of  outbreaks  of  diphtheria  and  scarlet 
fever  in  that  State  during  the  eleven  years  from  1887  to 
and  including  1898.  In  some  of  these  outbreaks  isola- 
tion and  disinfection  were  enforced,  in  others  thev  were 


396 


QUARANTINE. 


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398 


QUARANTINE. 


neglected.  The  detailed  results  are  given  in  Tables  I. 
and  II. ,  and  are  also  graphically  presented  in  Chart  I. 

These  studies  indicate  that  34,784  cases  and  7103 
deaths  were  saved  from  diphtheria,  and  31,228  cases  and 
1012  deaths  from  scarlet  fever,  during  the  eleven  years. 
If  we  take  into  consideration  the  immense  financial  sav- 
ing alone  that  is  represented  by  these  figures,  we  see  the 
great  economic  value  to  the  State  of  the  application  of 
these  preventive  measures,  a  large  part  of  which  can  no 
doubt  be  safely  attributed  to  the  employment  of  disin- 
fectants. 

The  value  of  isolation  and  disinfection  as  usually 
practised  is  shown  graphically  in  the  following  chart, 
reproduced  from  the  proceedings  of  the  third  annual 
conference  of  the  health  officers  of  Michigan,  1896: 


Isolation  and  Disinfection  in  Scarlet  Fever   and  Diph- 
theria in  Michigan  during  the  Five   Years  1886-go. 


Scarlet  Fever. 

Isolation  and  disinfection 
neglected     in    366 
outbreaks,  av'ge — 

Cases.    I    Deaths. 


enforced,     in     361 
outbreaks,  av'ge — 

Cases.     I  Deaths. 


I 


Diphtheria. 
Isolation  and  disinfection 

enforced  in  252 
outbreaks,  av'ge — 
Cases.     [  Deaths. 


neglected     in    317 
outbreaks,  av'ge — 

Cases.    I  Deaths. 


Figure  61  represents  influence  of  isolation  and  disin- 
fection in  scarlet  fever  according  to  recent  experience  in 
England.1 

1  Jour,  of  Hygiene,  vol.  i.,  1901. 


PERIOD  OF  DETENTION.  399 

Period  of  Isolation. — The  period  of  time  during 
which  the  infectiveness  of  a  patient  continues  varies  with 
each  disease.  In  the  exanthemata  the  quarantine  is 
usually  raised  two  weeks  after  the  eruption  has  entirely- 
disappeared,  except  for  small-pox,  for  which  the  period 
of  isolation  is  thirty  days.     In  diphtheria  the  quarantine 


—  No.  of  cases  'without  isolation 
and  disinfection. 


Inter-  epidemic  perioJ^ 
£pidentic  fseriod- 


No.  of  cases  tinder  imperfect 
isolation  and  disinfection. 

No.  of  cases  ivke?i  isolation 
and  disinfection  are  ap- 
p  roximately  pe7-fect. 


Fig.  61. — Isolation  and  disinfection  in  scarlet  fever. 

is  not  raised  until  cultures  taken  from  the  throat  of  the 
patient  fail  to  show  the  presence  of  the  diphtheria  bacil- 
lus. This  period  varies  very  greatly  in  different  cases, 
ranging  from  five  to  one  hundred  or  more  days  after  the 
total  disappearance  of  the  membrane. 

Period  of  Detention  of  Those  Exposed  to  the 
Infectious  Diseases. — Those  exposed  to  the  infectious 
diseases  are  detained  until  after  the  period  of  incubation 
of  the  particular  disease  has  elapsed.  The  following 
table  shows  the  period  of  incubation  of  the  more  com- 
mon infectious  diseases: 

Small-pox 12  days. 

Measles 10  " 

Scarlet  fever 3  " 

Diphtheria 3  " 

Cholera .10  " 

Typhoid  fever 14  " 

Yellow  fever 5  " 

If  no  new  outbreaks  occur  during  the  period  of  de- 
tention among  those  who  have  been  exposed  to  the  infec- 
tion, the  quarantine  is  raised  after  the  period  of  incuba- 
tion of  the  particular  disease  has  elapsed. 


400  QUARANTINE. 

Maritime  Quarantine.— Maritime  quarantine  is  prac- 
tised against  cholera,  typhus  fever,  yellow  fever,  small- 
pox, leprosy,  and  plague,  though  any  of  the  acute  infec- 
tious diseases  may  be  quarantined. 

In  a  recent  paper  on  modern  quarantine  in  Canada  and 
the  United  States,  Dr.  Montizambert,  of  Quebec,  states 
that  the  requirements  for  a  quarantine  station  are  held  to 
be  as  follows: 

"  i.  A  boarding  station,  so  placed  as  to  command  the 
channel  leading  to  the  port. 

"2.  A  boarding  steamer  fitted  with  hospital  cabins,  for 
landing  the  sick,  and  with  appliances  for  disinfecting  in 
the  offing  ships'  hospitals  with  mercuric  chlorid  douche, 
and  with  steam  when  such  disinfection  is  found  to  be  all 
that  the  vessel  requires. 

"3.  A  reserve  steamer  to  replace  the  usual  boarding 
steamer  on  emergency,  and — where  the  station  is  isolated 
— to  act  as  a  supply  and  mail  steamer,  for  forwarding 
convalescents,  etc. 

"4.  An  anchorage  for  vessels  under  quarantine  or  ob- 
servation. It  should  be  placed  conveniently  for  the  main 
establishment,  and  safely  remote  from  the  track  of  com- 
merce. 

"  5.  A  deep-water  pier.  The  depth  of  water  at  low 
tide  at  its  end  should  be  at  least  equal  to  the  draught  of 
the  largest  vessels  coming  to  the  port,  with  a  frontage 
sufficient  for  such  vessels  to  moor  to  it  if  required.  Upon 
this  pier  there  should  be  constructed — 

"  a.   A  warehouse; 

"  b.   Elevated  tanks  for  disinfecting  solutions; 

"  c.  A  disinfecting-house  containing  steam  disinfecting 
cylinders ; 

"  d.  Sulphur  furnace,  engine,  exhaust  fans,  etc.,  for 
fumigation. 

"6.  A  lazarette  or  hospital  for  the  treatment  of  infec- 
tious diseases. 

"7.  Separate  accommodations  for  non-infectious  cases 
from  infected  vessels  in  quarantine. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   401 

"  8.  Detention-houses  for  the  detention,  under  observa- 
tion, in  groups,  of  "  suspects ';  or  persons  who  have  been 
exposed  to  infection. 

"  9.    Quarters  for  officers  and  staff. 

"  10.  Telegraphic  communication  with  the  rest  of  the 
world.  Telephonic  communication  between  the  different 
parts  of  the  station. 

"11.   A  bacteriologic  laboratory. 

"12.  A  cremation  furnace  for  the  disposal  of  the  bodies 
of  those  who  have  died  of  infectious  diseases. ' ' 

Within  the  last  few  years  most  of  the  quarantine  sta- 
tions have  been  equipped  with  formaldehyd  gas  generators 
for  use  in  the  disinfection  of  infected  vessels. 

All  maritime  and  interstate  quarantine  powers  of  the 
United  States  have  been  conferred  upon  the  Supervising 
Surgeon-General  of  the  Marine-Hospital  Service,  and 
this  service  is  under  the  direction  of  the  Secretary  of  the 
Treasury.  The  following  is  a  careful  transcript  of  the 
acts  of  Congress  conferring  these  powers,  as  well  as  the 
quarantine  laws  of  the  United  States  : 

QUARANTINE  LAWS  OF  THE  UNITED  STATES. 

AN  ACT  Granting  Additional  Quarantine  Powers  and  Imposing  Ad- 
ditional Duties  upon  the  Marine-Hospital  Service. 

[Approved,  February  15,  1803.] 

Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the 
United  States  of  America  in  Congress  assembled,  That  it  shall  be 
unlawful  for  any  merchant  ship  or  other  vessel  from  any  foreign 
port  or  place  of  [to]  enter  any  port  of  the  United  States  except 
in  accordance  with  the  provisions  of  this  act  and  with  such  rules 
and  regulations  of  State  and  municipal  health  authorities  as  may 
be  made  in  pursuance  of,  or  consistent  with,  this  act ;  and  any 
such  vessel  which  shall  enter,  or  attempt  to  enter,  a  port  of  the 
United  States  in  violation  thereof  shall  forfeit  to  the  United 
States  a  sum,  to  be  awarded  in  the  discretion  of  the  court,  not 
exceeding  five  thousand  dollars,  which  shall  be  a  lien  upon  said 
vessel,  to  be  recovered  by  proceedings  in  the  proper  district  court 
of  the  United  States.  In  all  such  proceedings  the  United  States 
district  attorney  for  such  district  shall  appear  on  behalf  of  the 
United  States ;  and  all  such  proceedings  shall  be  conducted  in 

26 


402  QUARANTINE. 

accordance  with  the  rules  and  laws  governing  cases  of  seizure  of 
vessels  for  violation  of  the  revenue  laws  of  the  United  States. 

Sec.  2.  That  any  vessel  at  any  foreign  port  clearing  for  any 
port  or  place  in  the  United  States  shall  be  required  to  obtain 
from  the  consul,  vice-consul,  or  other  consular  officer  of  the 
United  States  at  the  port  of  departure,  or  from  the  medical  officer 
where  such  officer  has  been  detailed  by  the  President  for  that 
purpose,  a  bill  of  health,  in  duplicate,  in  the  form  prescribed  by 
the  Secretary  of  the  Treasury,  setting  forth  the  sanitary  history 
and  condition  of  said  vessel,  and  that  it  has  in  all  respects  com- 
plied with  the  rules  and  regulations  in  such  cases  prescribed  for 
securing  the  best  sanitary  condition  of  the  said  vessel,  its  cargo, 
passengers,  and  crew ;  and  said  consular  or  medical  officer  is 
required,  before  granting  such  duplicate  bill  of  health,  to  be 
satisfied  that  the  matters  and  things  therein  stated  are  true  ;  and 
for  his  services  in  that  behalf  he  shall  be  entitled  to  demand  and 
receive  such  fees  as  shall  by  lawful  regulation  be  allowed,  to  be 
accounted  for  as  is  required  in  other  cases. 

The  President,  in  his  discretion,  is  authorized  to  detail  any 
medical  officer  of  the  Government  to  serve  in  the  office  of  the 
consul  at  any  foreign  port  for  the  purpose  of  furnishing  informa- 
tion and  making  the  inspection  and  giving  the  bills  of  health 
hereinbefore  mentioned.  Any  vessel  clearing  and  sailing  from 
any  such  port  without  such  bill  of  health,  and  entering  any  port 
of  the  United  States,  shall  forfeit  to  the  United  States  not  more 
than  five  thousand  dollars,  the  amount  to  be  determined  by  the 
court,  which  shall  be  a  lien  on  the  same,  to  be  recovered  by  pro- 
ceedings in  the  proper  district  court  of  the  United  States.  In  all 
such  proceedings  the  United  States  district  attorney  for  such 
district  shall  appear  on  behalf  of  the  United  States  ;  and  all  such 
proceedings  shall  be  conducted  in  accordance  with  the  rules  and 
laws  governing  cases  of  seizure  of  vessels  for  violation  of  the 
revenue  laws  of  the  United  States. 

Sec.  3.  That  the  Supervising  Surgeon-General  of  the  Marine- 
Hospital  Service  shall,  immediately  after  this  act  takes  effect, 
examine  the  quarantine  regulations  of  all  State  and  municipal 
boards  of  health,  and  shall,  under  the  direction  of  the  Secretary 
of  the  Treasury,  cooperate  with  and  aid  State  and  municipal 
boards  of  health  in  the  execution  and  enforcement  of  the  rules 
and  regulations  of  such  boards  and  in  the  execution  and  en- 
forcement of  the  rules  and  regulations  made  by  the  Secretary  of 
the  Treasury,  to  prevent  the  introduction  of  contagious  or  in- 
fectious diseases  into  the  United  States  from  foreign  countries, 
and  into  one  State  or  Territory  or  the  District  Of  Columbia 
from  another  State  or  Territory  or  the  District  of  Columbia ; 
and  all  rules  and  regulations  made  by  the  Secretary  of  the 
Treasury  shall  operate  uniformly  and  in  no  manner  discriminate 
against  any  port  or  place  ;  and  at  such  ports  and  places  within 
the  United  States  as  have  no  quarantine  regulations  under  State 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   403 

or  municipal  authority,  where  such  regulations  are,  in  the  opinion 
of  the  Secretary  of  the  Treasury,  necessary  to  prevent  the  intro- 
duction of  contagious  or  infectious  diseases  into  the  United 
States  from  foreign  countries,  or  into  one  State  or  Territory  or 
the  District  of  Columbia  from  another  State  or  Territory  or  the 
District  of  Columbia,  and  at  such  ports  and  places  within  the 
United  States  where  quarantine  regulations  exist  under  the 
authority  of  the  State  or  municipality  which,  in  the  opinion  of 
the  Secretary  of  the  Treasury,  are  not  sufficient  to  prevent  the 
introduction  of  such  diseases  into  the  United  States,  or  into 
one  State  or  Territory  or  the  District  of  Columbia  from  another 
State  or  Territory  or  the  District  of  Columbia,  the  Secretary  of 
the  Treasury  shall,  if  in  his  judgment  it  is  necessary  and  proper, 
make  such  additional  rules  and  regulations  as  are  necessary  to 
prevent  the  introduction  of  such  diseases  into  the  United  States 
from  foreign  countries,  or  into  one  State  or  Territory  or  the 
District  of  Columbia  from  another  State  or  Territory  or  the  Dis- 
trict of  Columbia,  and  when  said  rules  and  regulations  have  been 
made  they  shall  be  promulgated  by  the  Secretary  of  the  Treasury 
and  enforced  by  the  sanitary  authorities  of  the  States  and  munici- 
palities, where  the  State  or  municipal  health  authorities  will  under- 
take to  execute  and  enforce  them  ;  but  if  the  State  or  municipal 
authorities  shall  fail  or  refuse  to  enforce  said  rules  and  regulations, 
the  President  shall  execute  and  enforce  the  same  and  adopt  such 
measures  as  in  his  judgment  shall  be  necessary  to  prevent  the 
introduction  or  spread  of  such  diseases,  and  may  detail  or  appoint 
officers  for  that  purpose.  The  Secretary  of  the  Treasury  shall 
make  such  rules  and  regulations  as  are  necessary  to  be  observed 
by  vessels  at  the  port  of  departure  and  on  the  voyage,  where  such 
vessels  sail  from  any  foreign  port  or  place  to  any  port  or  place  in 
the  United  States,  to  secure  the  best  sanitary  condition  of  such 
vessel,  her  cargo,  passengers,  and  crew ;  which  shall  be  published 
and  communicated  to  and  enforced  by  the  consular  officers  of  the 
United  States.  None  of  the  penalties  herein  imposed  shall  attach  to 
any  vessel  or  owner  or  officer  thereof  until  a  copy  of  this  act,  with 
the  rules  and  regulations  made  in  pursuance  thereof,  has  been 
posted  up  in  the  office  of  the  consul  or  other  consular  officer  of 
the  United  States  for  ten  days,  in  the  port  from  which  said  vessel 
sailed  ;  and  the  certificate  of  such  consul  or  consular  officer  over 
his  official  signature  shall  be  competent  evidence  of  such  posting 
in  any  court  of  the  United  States. 

Sec.  4.  That  it  shall  be  the  duty  of  the  Supervising  Surgeon- 
General  of  the  Marine-Hospital  Service,  under  the  direction  of 
the  Secretary  of  the  Treasury,  to  perform  all  the  duties  in  respect 
to  quarantine  and  quarantine  regulations  which  are  provided  for 
by  this  act,  and  to  obtain  information  of  the  sanitary  condition 
of  foreign  ports  and  places  from  which  contagious  and  infectious 
diseases  are  or  may  be  imported  into  the  United  States,  and  to 
this  end  the  consular  officers  of  the  United  States  at  such  ports 


404  QUARANTINE. 

and  places  as  shall  be  designated  by  the  Secretary  of  the  Treas- 
ury shall  make  to  the  Secretary  of  the  Treasury  weekly  reports  of 
the  sanitary  condition  of  the  ports  and  places  at  which  they  are 
respectively  stationed,  according  to  such  forms  as  the  Secretary 
of  the  Treasury  shall  prescribe ;  and  the  Secretary  of  the  Treas- 
ury shall  also  obtain,  through  all  sources  accessible,  including 
State  and  municipal  sanitary  authorities  throughout  the  United 
States,  weekly  reports  of  the  sanitary  condition  of  ports  and 
places  within  the  United  States,  and  shall  prepare,  publish,  and 
transmit  to  collectors  of  customs  and  to  State  and  municipal 
health  officers  and  other  sanitarians  weekly  abstracts  of  the  con- 
sular sanitary  reports  and  other  pertinent  information  received  by 
him,  and  shall  also,  as  far  as  he  may  be  able,  by  means  of  the 
voluntary  cooperation  of  State  and  municipal  authorities,  of  public 
associations,  and  private  persons,  procure  information  relating  to 
the  climatic  and  other  conditions  affecting  the  public  health,  and 
shall  make  an  annual  report  of  his  operations  to  Congress,  with 
such  recommendations  as  he  may  deem  important  to  the  public 
interests. 

Sec.  5.  That  the  Secretary  of  the  Treasury  shall  from  time  to 
time  issue  to  the  consular  officers  of  the  United  States  and  to  the 
medical  officers  serving  at  any  foreign  port,  and  otherwise  make 
publicly  known,  the  rules  and  regulations  made  by  him,  to  be 
used  and  complied  with  by  vessels  in  foreign  ports,  for  securing 
the  best  sanitary  condition  of  such  vessels,  their  cargoes,  passen- 
gers, and  crew,  before  their  departure  for  any  port  in  the  United 
States,  and  in  the  course  of  the  voyage  :  and  all  such  other  rules 
and  regulations  as  shall  be  observed  in  the  inspection  of  the 
same  on  the  arrival  thereof  at  any  quarantine  station  at  the  port 
of  destination,  and  for  the  disinfection  and  isolation  of  the  same, 
and  the  treatment  of  cargo  and  persons  on  board,  so  as  to  pre- 
vent the  introduction  of  cholera,  yellow  fever,  or  other  contagious 
or  infectious  diseases ;  and  it  shall  not  be  lawful  for  any  vessel 
to  enter  said  port  to  discharge  its  cargo,  or  land  its  passengers, 
except  upon  a  certificate  of  the  health  officer  at  such  quarantine 
station  certifying  that  said  rules  and  regulations  have  in  all 
respects  been  observed  and  complied  with,  as  well  on  his  part 
as  on  the  part  of  the  said  vessel  and  its  master,  in  respect  to 
the  same  and  to  its  cargo,  passengers,  and  crew;  and  the  master 
of  every  such  vessel  shall  produce  and  deliver  to  the  collector  of 
customs  at  said  port  of  entry,  together  with  the  other  papers  of 
the  vessel,  the  said  bills  of  health  required  to  be  obtained  at  the 
port  of  departure  and  the  certificate  herein  required  to  be  obtained 
from  the  health  officer  at  the  port  of  entry  :  and  that  the  bills 
of  health  herein  prescribed  shall  be  considered  as  part  of  the 
ship's  papers,  and  when  duly  certified  to  by  the  proper  consular 
officer  or  other  officer  of  the  United  States,  over  his  official  signa- 
ture and  seal,  shall  be  accepted  as  evidence  of  the  statements 
therein  contained  in  any  court  of  the  United  States. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  405 

Sec.  6.  That  on  the  arrival  of  an  infected  vessel  at  any  port 
not  provided  with  proper  facilities  for  treatment  of  the  same, 
the  Secretary  of  the  Treasury  may  remand  said  vessel,  at  its  own 
expense,  to  the  nearest  national  or  other  quarantine  station, 
where  accommodations  and  appliances  are  provided  for  the  neces- 
sary disinfection  and  treatment  of  the  vessel,  passengers,  and 
cargo  ;  and  after  treatment  of  any  infected  vessel  at  a  national 
quarantine  station,  and  after  certificate  shall  have  been  given  by 
the  United  States  quarantine  officer  at  said  station  that  the  vessel, 
cargo,  and  passengers  are  each  and  ail  free  from  infectious  disease, 
or  danger  of  conveying  the  same,  said  vessel  shall  be  admitted 
to  entry  to  any  port  of  the  United  States  named  within  the  cer- 
tificate. But  at  any  ports  where  sufficient  quarantine  provision 
has  been  made  by  State  or  local  authorities  the  Secretary  of  the 
Treasury  may  direct  vessels  bound  for  said  ports  to  undergo  quar- 
antine at  said  State  or  local  station. 

Sec.  7.  That  whenever  it  shall  be  shown  to  the  satisfaction  of 
the  President  that  by  reason  of  the  existence  of  cholera  or  other 
infectious  or  contagious  diseases  in  a  foreign  country  there  is 
serious  danger  of  the  introduction  of  the  same  into  the  United 
States,  and  that  notwithstanding  the  quarantine  defence  this 
danger  is  so  increased  by  the  introduction  of  persons  or  property 
from  such  country  that  a  suspension  of  the  right  to  introduce 
the  same  is  demanded  in  the  interest  of  the  public  health,  the 
President  shall  have  power  to  prohibit,  in  whole  or  in  part,  the 
introduction  of  persons  and  property  from  such  countries  or 
places  as  he  shall  designate  and  for  such  period  of  time  as  he  may 
deem  necessary. 

Sec.  8.  That  whenever  the  proper  authorities  of  a  State  shall 
surrender  to  the  United  States  the  use  of  the  buildings  and  dis- 
infecting apparatus  at  a  State  quarantine  station  the  Secretary  of. 
the  Treasury  shall  be  authorized  to  receive  them  and  to  pay  a 
reasonable  compensation  to  the  State  for  their  use,  if,  in  his 
opinion,  they  are  necessary  to  the  United  States. 

Sec.  9.  That  the  act  entitled  "  An  act  to  prevent  the  introduc- 
tion of  infectious  or  contagious  diseases  into  the  United  States, 
and  to  establish  a  national  board  of  health,"  approved  March  3, 
1879,  be,  and  the  same  is  hereby,  repealed.  And  the  Secretary 
of  the  Treasury  is  directed  to  obtain  possession  of  any  property, 
furniture,  books,  paper,  or  records  belonging  to  the  United 
States  which  are  not  in  the  possession  of  an  officer  of  the  United 
States  under  the  Treasury  Department  which  were  formerly  in  the 
use  of  the  National  Board  of  Health  or  any  officer  or  employe 
thereof. 

[Act  of  Congress,  approved  August  i8,  1894.] 

AN  ACT  to  amend  section  two  of  the  act  approved  February  fifteenth,  eigh- 
teen hundred  and  ninety-three,  entitled  "An  act  granting  additional  quar- 
antine powers  and  imposing  additional  duties  upon  the  Marine-Hospital 
Service." 


406  QUARANTINE. 

Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the 
United  States  of  America  in  Congress  assembled,  That  section 
two  of  the  act  approved  February  fifteenth,  eighteen  hundred  and 
ninety-three,  entitled  "An  act  granting  additional  quarantine 
powers  and  imposing  additional  duties  upon  the  Marine-Hospital 
Service,"  is  hereby  amended  by  adding  to  the  end  of  said  section 
the  following  : 

"  The  provisions  of  this  section  shall  not  apply  to  vessels  plying 
between  foreign  ports  on  or  near  the  frontiers  of  the  United 
States  and  ports  of  the  United  States  adjacent  thereto ;  but  the 
Secretary  of  the  Treasury  is  hereby  authorized,  when,  in  his 
discretion,  it  is  expedient  for  the  preservation  of  the  public 
health,  to  establish  regulations  governing  such  vessels." 

REVISED    STATUTES. 

Sec.  4794.  There  shall  be  purchased  or  erected,  under  the 
orders  of  the  President,  suitable  warehouses,  with  wharves  and 
inclosures,  where  merchandise  may  be  unladen  and  deposited 
from  any  vessel  which  shall  be  subject  to  a  quarantine  or  other 
restraint,  pursuant  to  the  health  laws  of  any  State,  at  such  con- 
venient places  therein  as  the  safety  of  the  public  revenue  and 
the  observance  of  such  health  laws  may  require. 

Sec.  4795.  Whenever  the  cargo  of  a  vessel  is  unladen  at  some 
other  place  than  the  port  of  entry  or  delivery  under  the  fore- 
going provisions,  all  the  articles  of  such  cargo  shall  be  deposited, 
at  the  risk  of  the  parties  concerned  therein,  in  such  public  or 
other  warehouses  or  inclosures  as  the  collector  shall  designate, 
there  to  remain  under  the  joint  custody  of  such  collector  and 
of  the  owner,  or  master,  or  other  person  having  charge  of  such 
■vessel,  until  the  same  are  entirely  unladen  or  discharged,  and 
until  the  articles  so  deposited  may  be  safely  removed  without 
contravening  such  health  laws.  And  when  such  removal  is  al- 
lowed, the  collector  having  charge  of  such  articles  may  grant 
permits  to  the  respective  owners  or  consignees,  their  factors  or 
agents,  to  receive  all  merchandise  which  has  been  entered,  and 
the  duties  accruing  upon  which  have  been  paid,  upon  the  pay- 
ment by  them  of  a  reasonable  rate  of  storage  ;  which  shall  be 
fixed  by  the  Secretary  of  the  Treasury  for  all  public  warehouses 
and  inclosures. 

Sec.  4796.  The  Secretary  of  the  Treasury  is  authorized,  when- 
ever a  conformity  to  such  quarantine  and  health  laws  requires 
it,  and  in  respect  to  vessels  subject  thereto,  to  prolong  the  terms 
limited  for  the  entry  of  the  same  and  the  report  or  entry  of  their 
cargoes,  and  to  vary  or  dispense  with  any  other  regulations  ap- 
plicable to  such  reports  or  entries.  No  part  of  the  cargo  of  any 
vessel  shall,  however,  in  any  case  be  taken  out  or  unladen  there- 
from otherwise  than  is  allowed  by  law,  or  according  to  the 
regulations  hereinafter  established. 


QUARANTINE  LA  WS  OF  THE  UNITED  STA  TES.   407 

Sec.  4797.  Whenever,  by  the  prevalence  of  any  contagious  or 
epidemic  disease  in  or  near  the  place  by  law  established  as  the 
port  of  entry  for  any  collection  district,  it  becomes  dangerous 
or  inconvenient  for  the  officers  of  the  revenue  employed  therein 
to  continue  the  discharge  of  their  respective  offices  at  such  port, 
the  Secretary  of  the  Treasury,  or,  in  his  absence,  the  First  Comp- 
troller, may  direct  the  removal  of  the  officers  of  the  revenue 
from  such  port  to  any  other  more  convenient  place  within  or  as 
near  as  may  be  to  such  collection  district.  And  at  such  place 
such  officers  may  exercise  the  same  powers  and  shall  be  liable 
to  the  same  duties,  according  to  existing  circumstances,  as  in 
the  port  or  district  established  by  law.  Public  notice  of  any 
such  removal  shall  be  given  as  soon  as  may  be. 

Sec.  4798.  In  case  of  the  prevalence  of  a  contagious  or  epi- 
demic disease  at  the  seat  of  Government,  the  President  may 
permit  and  direct  the  removal  of  any  or  all  the  public  offices  to 
such  other  place  or  places  as  he  shall  deem  most  safe  and  con- 
venient for  conducting  the  public  business. 

Sec.  4799.  Whenever,  in  the  opinion  of  the  Chief  Justice,  or, 
in  case  of  his  death  or  inability,  of  the  senior  associate  justice, 
of  the  Supreme  Court,  a  contagious  or  epidemic  sickness  shall 
render  it  hazardous  to  hold  the  next  stated  session  of  the  court  at 
the  seat  of  Government,  the  chief  or  such  associate  justice  may 
issue  his  order  to  the  marshal  of  the  Supreme  Court,  directing 
him  to  adjourn  the  next  session  of  the  court  to  such  other  place 
as  such  justice  deems  convenient.  The  marshal  shall  thereupon 
adjourn  the  court  by  making  publication  thereof  in  one  or  more 
public  papers  printed  at  the  seat  of  Government  from  the  time  he 
shall  receive  such  order  until  the  time  by  law  prescribed  for  com- 
mencing the  session.  The  several  circuit  and  district  judges 
shall,  respectively,  under  the  same  circumstances,  have  the  same 
power,  by  the  same  means,  to  direct  adjournments  of  the  several 
circuit  and  district  courts  to  some  convenient  place  within  their 
districts,  respectively. 

Sec.  4800.  The  judge  of  any  district  court  within  whose  dis- 
trict any  contagious  or  epidemic  disease  shall  at  any  time  prevail, 
so  as,  in  his  opinion,  to  endanger  the  lives  of  persons  confined  in 
the  prison  of  such  district,  in  pursuance  of  any  law  of  the  United 
States,  may  direct  the  marshal  to  cause  the  persons  so  confined  to 
be  removed  to  the  next  adjacent  prison  where  such  disease  does 
not  prevail,  there  to  be  confined  until  they  may  safely  be  removed 
back  to  the  place  of  their  first  confinement.  Such  removals  shall 
be  at  the  expense  of  the  United  States. 

Sec.  4263.  The  master  of  any  vessel  employed  in  transporting 
passengers  between  the  United  States  and  Europe  is  authorized  to 
maintain  good  discipline  and  such  habits  of  cleanliness  among 
the  passengers  as  will  tend  to  the  preservation  and  promotion  of 
health,  and  to  that  end  he  shall  cause  such  regulations  as  he  may 
adopt  for  this  purpose  to  be  posted  up,  before  sailing,  on  board 


4o8  QUARANTINE. 

such  vessel,  in  a  place  accessible  to  such  passengers,  and  shall 
keep  the  same  so  posted  up  during  the  voyage.  Such  master 
shall  cause  the  apartments  occupied  bv  such  passengers  to  be 
kept  at  all  times  in  a  clean,  healthy  state  ;  and  the  owners  of 
every  such  vessel  so  employed  are  required  to  construct  the 
decks  and  all  parts  of  the  apartments  so  that  they  can  be  thor- 
oughly cleansed,  and  also  to  provide  a  safe,  convenient  privy,  or 
water-closet,  for  the  exclusive  use  of  every  one  hundred  such 
passengers.  The  master  shall  also,  when  the  weather  is  such  that 
the  passengers  can  not  be  mustered  on  deck  with  their  bedding, 
and  at  such  other  times  as.  he  may  deem  necessary,  cause  the 
deck  occupied  by  such  passengers  to  be  cleansed  with  chlorid 
of  lime  or  some  other  equally  efficient  disinfecting  agent.  And 
for  each  neglect  or  violation  of  any  of  the  provisions  of  this 
section  the  master  and  owner  of  any  such  vessel  shall  be  sever- 
ally liable  to  the  United  States  in  a  penalty  of  fifty  dollars,  to 
be  recovered  in  any  circuit  or  district  court  within  the  jurisdic- 
tion of  which  such  vessel  may  arrive  or  from  which  she  is  about 
to  depart,  or  at  any  place  where  the  owner  or  master  may  be 
found. 

[Extract  from  act  August  i,  1888.] 

Whenever  any  person  shall  trespass  upon  the  grounds  belong- 
ing to  any  quarantine  reservation,  such  person,  trespassing,  shall, 
upon  conviction  thereof,  pay  a  fine  of  not  more  than  three  hun- 
dred dollars,  or  be  sentenced  to  imprisonment  for  a  period  of 
not  more  than  thirty  days,  or  shall  be  punished  by  both  fine  and 
imprisonment,  at  the  discretion  of  the  court.  And  it  shall  be 
the  duty  of  the  United  States  Attorney  in  the  district  where  the 
misdemeanor  shall  have  been  committed  to  take  immediate  cog- 
nizance of  the  offence,  upon  report  made  to  him  by  any  medical 
officer  of  the  Marine-Hospital  Service,  or  by  any  officer  of  the 
customs  service,  or  by  any  State  officer  acting  under  authority 
of  section  five  of  said  act. 


QUARANTINE    REGULATIONS   TO  BE  OBSERVED   AT 
FOREIGN  PORTS  AND  AT  SEA. 

Article  I. — Bills  of  Health. 

Par.  i.  Masters  of  vessels  departing  from  any  foreign  port  for 
a  port  in  the  United  States  must  obtain  a  bill  of  health  in  du- 
plicate, signed  by  the  proper  officer  or  officers  of  the  United 
States  as  provided  for  by  law,  except  as  provided  for  in  par.  5. 

The  following  form  is  prescribed  : 

Par.  2.   Bill  of  health  : 


QUARANTINE  LA  WS  OF  THE  UNITED  STA  TES.   409 

Form  No.  1931  a. 
United  States  Bill  of  Health. 

Name  of  vessel,  .   Nationality,  .    Rig, .   Master, . 

Tonnage',  gross,  ;  net, .     Iron  or  wood.     Number  of  compart- 
ments for  cargo,  ;  for  steerage  passengers, ;  for  crew, . 

Name  of  medical  officer,  . 

Number  of  officers, . 

Number  of  members  of  officers'  families, . 

Number  of  crew,  including  petty  officers,  . 

Number  of  passengers,  cabin,  — •. 

Number  of  passengers,  steerage, . 

Number  of  persons  on  board,  all  told,  . 

Port  of  departure, . 

Where  last  from, . 

Number  of  cases  of  sickness  and  character,  during  last  voyage,  . 

Vessel  engaged  in trade,  and  plies  between and . 

Sanitary  condition  of  vessel,  ■ — . 

Nature,  sanitary  history,  and  condition  of  cargo, . 

Source  and  wholesomeness  of  water-supply, . 

Source  and  wholesomeness  of  food-supply, . 

Sanitary  history  and  health  of  officers  and  crew,  ■ — . 

Sanitary  history  and  health  of  passengers,  cabin, . 

Sanitary  history  and  health  of  passengers,  steerage,  . 

Sanitary  history  and  condition  of  their  effects,  . 

Prevailing  diseases  at  port  and  vicinity,  . 

Location  of  vessel  while  discharging  and  loading — open  bay  or  wharf, . 

Number  of  cases  and  deaths  from  the  following-named  diseases  during  the 
past  two  weeks : 

Diseases.  No.  of  cases.     No.  of  deaths. 

Yellow  fever 

Asiatic    cholera ■ 

Cholera  nostras    or  cholerine 

Small-pox ■  

Typhus    fever 

Plague 

Leprosy  

Number  of  cases  of  sickness  and  character  of  same  while  vessel  was  in  this 
port,  — — ■ — ■  . 

Any  conditions  affecting  the  public  health  existing  in  the  port  of  departure  or 
vicinity  to  be  here  stated,  . 

I  certify  that  the  vessel  has  complied  with  the  rules  and  regulations  made 
under  the  act  of  February  15,  1893,  an(^  tnat  trie  vessel  leaves  this  port  bound 
for ,  U.  S.  of  America,  via . 

Given  under  my  hand  and  seal  this day  of ,  190  . 

(Signature  of  consular  officer:) — , 


Par.  3.  Vessels  clearing  from  a  foreign  port  for  any  port  in 
the  United  States,  and  entering  or  calling  at  intermediate  ports, 
must  procure  at  all  said  ports  a  supplemental  bill  of  health  signed 
as  provided  in  Article  I.  If  a  quarantinable  disease  has  appeared 
on  board  the  vessel  after  leaving  the  original  port  of  departure, 
or  other  circumstances  presumably  render  the  vessel  infected,  the 
supplemental  bill  of  health  should  be  withheld  until  such  sanitary 
measures  have  been  taken  as  are  necessary. 

The  following  form  is  prescribed  : 


4-io 


QUARANTINE. 


Par.  4.- 


Yessel 


Supplemental  Bill  of  Health. 


Port  of 


bound  from 


U.  S.  A. 


Sanitary  condition  of  port, . 

State  diseases  prevailing  at  port  and  in  surrounding  country, . 

Number  of  cases  and  the  deaths   from  the   following-named    diseases  during 
the  past  two  weeks  : 


No.  of 
cases. 


No.  of 
deaths. 


Remarks. 
(Any  condition  affecting  the  public  health  exist- 
ing in  the  port  to  be  stated  here.) 


Yellow    fever  .    . 
Asiatic  cholera  or 

cholerine  .  .  . 
Small-pox  .  .  . 
Typhus  fever  .  . 
Plague  .... 
Leprosy    .... 


Number  and  sanitary  condition  of  passengers  and  crew  landed  at  this  port. 

Cabin,  No.  .     Sanitary  condition  and  history, . 

Steerage,  No.  .     Sanitary  condition  and  history,  . 

Crew,  No. .      Sanitary  condition  and  histoiy,  . 

Sanitary  condition  of  effects, . 

Note. — If  disembarked  on  account  of  sickness,  state  disease, . 


Number  and  sanitary  condition   of  passengers  and  crew  taken  on  at  this  port, 
and  sanitary  condition  of  effects. 

Cabin,  No.  .     Sanitary  condition  and  history,  . 

Steerage,  No.  .     Sanitary  condition  and  history, . 

Crew,  No. .     Sanitary  condition  and  history,  . 

Sanitary  condition  of  effects,  . 


Sanitary  history  of  vessel  since  leaving  last po?-t. 
(Cancel  Form  A,  B,  or  C,  as  the  case  requires.) 


A. — To  the  best  of  my  knowledge  and  belief —  "] 

(Form   A   will   be  used   at   intermediate  ports 
where  the  vessel  does  not  enter  and  clear.) 

B. — I  have  satisfied  myself  that — 


no  quarantinable  disease  has 
appeared  aboard  since 
leaving . 


(Form  B   will  be  used   at   intermediate    ports 
where  the  vessel  enters  and  clears.)  J 

C. — Since  leaving the    following  quarantinable  disease  has  appeared  on 

board ,  and  I  certify  that  the  necessary  sanitary  measures  have   been 

taken. 

I  certify  also  that  with  reference  to  the  passengers,  effects,  and  cargo  taken 
on  at  this  port,  the  vessel  has  complied  with  the  rules  and  regulations  made 
under  the  act  of  February  15,  1893. 

Given  under  my  hand  and  seal  this day  of ,  190  . 

(Signature  of  consular  officer  :) , 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   41 1 

Par.  5.  Under  the  act  of  Congress  approved  August  18,  1894, 
vessels  plying  between  Canadian  ports  on  the  St.  Croix  River, 
the  St.  Lawrence  River,  the  Niagara  River,  the  Detroit  River,  the 
St.  Clair  River,  and  the  St.  Mary's  River,  and  adjacent  ports  of 
the  United  States  on  the  same  waters  ;  also  vessels  plying  between 
Canadian  ports  on  the  following-named  lakes,  viz.,  Ontario,  Erie, 
St.  Clair,  Huron,  Superior,  Rainy  Lake,  Lake  of  the  Woods, 
Lake  Champlain,  and  ports  in  the  United  States ;  also  vessels 
plying  between  Mexican  ports  on  the  Rio  Grande  River  and  ad- 
jacent ports  in  the  United  States,  are  exempt  from  the  provisions 
of  section  2  of  the  act  granting  additional  quarantine  powers  and 
imposing  additional  duties  upon  the  Marine-Hospital  Service, 
approved  February  15,  1893,  which  requires  vessels  clearing  from 
a  foreign  port  for  a  port  in  the  United  States  to  obtain  from  the 
consular  officer  a  bill  of  health. 

During  the  prevalence  of  any  of  the  quarantinable  diseases  at 
the  foreign  port  of  departure,  vessels  above  referred  to  are  hereby 
required  to  obtain  from  the  consular  officer  of  the  United  States, 
or  from  the  medical  officer  of  the  United  States,  when  such 
officer  has  been  detailed  by  the  President  for  this  purpose,  a  bill 
of  health,  in  duplicate,  in  the  form  prescribed  by  the  Secretary 
of  the  Treasury,  Quarantine  Regulations  of  the  United  States,  1894. 

Article  II. — Inspection. 

Par.  1.  The  officer  issuing  the  bill  of  health  will  satisfy  him- 
self, by  inspection  .if  necessary,  that  the  conditions  certified  to 
therein  are  true. 

Par.  2.   Inspection  is  required  of — 

(a)  All  vessels  from  ports  at  which  cholera  prevails,  or  at 
which  yellow  fever,  small-pox,  or  typhus  fever  prevails  in  epidemic 
form. 

(b)  All  vessels  carrying  steerage  passengers. 

But  the  inspection  of  this  class  may  be  limited  to  said  passen- 
gers and  their  living  apartments,  if  from  a  healthy  port. 

Par.  3.  Inspection  of  the  vessel  is  such  an  examination  of  the 
vessel,  cargo,  passengers,  crew,  personal  effects  of  same,  and 
including  examination  of  manifests  and  other  papers,  food-  and 
water-supply,  as  will  enable  him  to  determine  if  these  regula- 
tions have  been  complied  with. 

Par.  4.  When  an  inspection  is  required,  it  should  be  made  by 
daylight,  as  late  as  practicable  before  sailing.  The  vessel  should 
be  inspected  before  the  passengers  go  aboard,  the  passengers  just 
before  embarkation,  and  the  crew  on  deck  ;  and  no  cargo  or 
person  should  be  allowed  to  come  aboard  after  such  inspection 
except  by  permission  of  the  officer  issuing  the  bill  of  health. 

Article  III. — Requirements  with  Regard    to  Vessels. 
Par.  i.   Vessels,    prior  to  stowing  cargo  or  receiving  passen- 
gers, shall  be  mechanically  clean  in  all  parts,  especially  "the  hold, 


412  QUARANTINE. 

forecastle,  and  steerage  ;  the  bilges  and  limbers  free  from  odor 
and  deposit.  The  air  streaks  should  be  sufficient  in  number  and 
open  for  ventilation.  Disinfection  of  the  vessel  may  be  required 
by  the  medical  officer  of  the  United  States. 

Par.  2.  If  any  infectious  disease  has  occurred  during  the  last 
voyage,  the  portions  of  the  vessel  liable  to  have  been  infected 
should  be  disinfected.  When  required,  this  should  be  done  by 
one  of  the  methods  hereinafter  described. 

Par.  3.  The  air  space  and  ventilation  must  conform  to  the 
provisions  of  the  act  of  Congress  approved  August  2,  1882,  en- 
titled "  An  act  to  regulate  the  carriage  of  passengers  by  sea."  ] 

Par.  4.  The  food-  and  water-supply  should  be  sufficient,  and 
water  for  drinking-purposes,  free  from  possibility  of  pollution, 
should  be  easily  accessible. 

Par.  5.  Vessels  departing  from  a  port  where  cholera  prevails 
should  have  two  medical  officers  if  more  than  250  steerage  pas- 
sengers are  carried. 

Par.  6.  All  bedding  provided  for  steerage  passengers  must  be 
destroyed  or  disinfected  before  being  again  used  or  landed,  and 
mattresses  and  pillows  used  by  steerage  passengers  shall  not  be 
landed. 

Par.  7.  The  hospitals  of  vessels  carrying  steerage  passengers 
should  be  located  on  the  upper  or  second  deck,  and  not  in  direct 
communication  with  any  steerage  compartment. 

Par.  8.  Excepting  when  absolutely  required,  no  solid  parti- 
tions should  be  placed  in  any  steerage  compartment,  obstructing 
light  and  air. 

Article  IV. — Cargo. 

Par.  i.  At  ports  infected  with  cholera,  earth,  sand,  loam,  soft 
or  porous  rock  should  not  be  taken  as  ballast.  Nor  at  ports  in- 
fected with  yellow  fever  should  such  ballast  be  allowed  on  board 
vessels  clearing  for  ports  south  of  the  southern  boundary  of  Mary- 
land, when  better  material,  such  as  hard  rock,  is  obtainable,  or 
when  it  is  possible  to  use  water  ballast. 

Par.  2.  Certain  food  products,  viz.,  unsalted  meats,  sausages, 
dressed  poultry,  dried  and  smoked  meats,  rennets,  fresh  butter, 
fresh  milk  (unsterilized),  fresh  cheese,  fresh  bread,  fresh  vege- 
tables, coming  from  cholera-infected  localities  or  through  such 
localities,  if  exposed  to  infection  therein,  should  not  be  shipped. 

Par.  3.  Fresh  fruits  from  districts  where  cholera  prevails  shall 
be  shipped  only  under  such  sanitary  supervision  as  will  enable 
the  inspector  to  certify  that  they  have  not  been  exposed  to  infec- 
tion. 

Par.  4.  Articles  of  merchandise,  personal  effects,  and  bedding, 
coming  from  a  district  known  to  be  infected,  or  as  to  the  origin 

1  Computation  of  air  space  in  any  steerage  compartment  must  not  include 
the  space  taken  up  by  bunks,  mattresses,  life-preservers,  or  personal  effects. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   413 

of  which  no  positive  evidence  can  be  obtained,  and  which  the 
consular  or  medical  officer  has  reason  to  believe  are  infected, 
should  be  subjected  to  disinfection  prior  to  shipment  by  processes 
prescribed  for  articles  according  to  their  class. 

Par.  5.  New  merchandise  in  general  may  be  accepted  for  ship- 
ment without  question ;  and  articles  of  new  merchandise,  textile 
fabrics,  and  the  like,  which  have  been  packed  or  prepared  for 
shipment  in  an  infected  port  or  place,  with  a  special  view  to 
protect  the  same  from  moisture  incident  to  the  voyage,  may  be 
accepted  and  exempted  from  disinfection. 

Par.  6.  All  rags  and  textile  fabrics  used  in  the  manufacture 
of  paper  and  for  other  purposes,  which  are  collected,  packed, 
or  handled  in  any  foreign  port  or  place,  with  the  exceptions  as 
hereinafter  specified,  shall,  prior  to  shipment  to  the  United 
States,  be  subjected  to  disinfection  by  one  of  the  prescribed 
methods.  (Old  jute  bags,  old  cotton  bags,  old  rope,  new  cotton 
or  linen  cuttings  from  factories,  not  included.) 

The  disinfection  of  the  articles  mentioned  herein  shall  be  per- 
formed under  the  supervision  of  a  United  States  consul  or  a 
medical  officer  of  the  United  States ;  and  a  certificate  in  dupli- 
cate, signed  by  said  consul  or  medical  officer,  shall  be  issued 
with  each  consignment  of  same,  which  certificate  shall  identify 
the  articles,  and  state  that  they  have  been  disinfected  in  accord- 
ance with  the  United  States  quarantine  regulations.  The  original 
certificate  of  disinfection  shall  be  attached  to  the  consignee's 
invoice,  and,  where  the  articles  are  carried  by  sea,  the  duplicate 
Certificate  of  disinfection  shall  be  attached  to  the  bill  of  health 
issued  to  the  vessel  conveying  same. 

Exception. — Such  articles  shipped  from  the  Dominion  of 
Canada  directly  to  the  United  States  shall  be  exempt  from  this 
requirement  if  accompanied  by  affidavits  demonstrating  to  the 
satisfaction  of  the  collector  of  customs  at  the  port  of  arrival 
that  they  have  actually  originated  in  Canada,  and  have  not  been 
shipped  from  a  foreign  country  to  Canada,  and  thence  shipped 
to  the  United  States  ;  and  further,  that  the  port  or  place  where 
collected  or  handled  has  been  free  from  quarantinable  disease  for 
thirty  days  prior  to  shipment. 

Par.  7.  Rags,  old  jute,  old  gunny,  old  rope,  and  similar 
articles,  gathered  or  packed  or  handled  in  any  port  or  place  where 
cholera  or  yellow  fever  prevails,  or  small-pox  or  typhus  fever  pre- 
vails in  epidemic  form,  should  not  be  shipped  until  the  officer 
issuing  the  bill  of  health  shall  be  satisfied  that  the  port  or  place 
has  been  for  thirty  days  free  from  such  infection,  and  after  the 
disinfection  of  the  articles. 

Par.  8.  New  feathers  for  bedding  ;  human  and  other  hair, 
unmanufactured  ;  bristles ;  wool ;  hides  not  chemically  cured, 
coming  from  a  district  where  cholera  prevails,  shall  be  refused 
shipment  until  thirty  days  have  elapsed  since  last  exposure,  un- 
less unpacked  and  disinfected  as  hereinafter  provided. 


414  QUARANTINE. 

Feathers  which  have  been  used  should  be  disinfected,  and  in- 
variably by  steam. 

Par.  9.  The  articles  enumerated  in  the  preceding  paragraph 
coming  from  a  district  where  yellow  fever  prevails,  destined  for 
ports  or  places  south  of  the  southern  boundary  of  Maryland 
during  the  quarantine  season,  or  where  small-pox  or  typhus  fever 
prevails  in  epidemic  form,  should  be  refused  shipment  unless 
disinfected  as  hereinafter  provided. 

Par.  10.  Articles  such  as  gelatin,  glue,  glue-stock,  fish  glue, 
fish  bladders,  fish  skins,  sausage  casings,  bladders,  dried  blood, 
having  been  in  any  way  liable  to  infection  in  the  process  of  prep- 
aration, gathering,  or  shipment,  should  be  disinfected. 

Par.  11.  Any  covering,  shipped  from  or  through  an  infected 
port  or  place,  and  which  the  consul  or  medical  officer  has  reason 
to  believe  infected,  should  be  disinfected. 

Par.  12.  Any  article  presumably  infected,  which  can  not  be 
disinfected,  should  not  be  shipped. ' 

Article  V. — Passengers  and  Crew. 

Par.  1.  Passengers,  for  the  purposes  of  these  regulations,  are 
divided  into  two  classes,  cabin  and  steerage. 

Par.  2.  No  person  suffering  from  a  quarantinable  disease,  or 
scarlet  fever,  measles,  or  diphtheria,  should  be  allowed  to  ship. 

Par.  3.  Steerage  passengers  and  crew  coming  from  districts 
where  small-pox  prevails  in  epidemic  form,  or  who  have  been  ex- 
posed to  small-pox,  shall  be  vaccinated  before  embarkation,  unless 
they  show  evidence  of  immunity  to  small-pox  by  previous  attack 
or  recent  successful  vaccination. 

Par.  4.  Steerage  passengers  and  crew  who,  in  the  opinion  of 
the  inspecting  officer,  have  been  exposed  to  the  infection  of 
typhus  fever,  should  not  be  allowed  to  embark  for  a  period  of  at 
least  fourteen  days  after  such  exposure  and  the  disinfection  of 
their  baggage. 

Par.  5.  When  practicable,  passengers  should  not  ship  from  an 
infected  port.  Steerage  passengers  coming  from  cholera-infected 
districts  must  be  detained  five  days  in  suitable  houses  or  barracks 
located  where  there  is  no  danger  from  infection,  and  all  baggage 
disinfected  as  hereinafter  provided  ;  the  said  period  of  five  days 
to  begin  only  after  the  bathing  of  the  passengers,  disinfection  of 
all  their  baggage  and  apparel,  removal  of  all  food  brought  with 
them,  and  isolation  from  others  not  so  treated. 

Par.  6.  Steerage  passengers  from  districts  not  infected  with 
cholera,  shipping  at  a  port  infected  with  cholera,  unless  passed 
through  without  danger  of  infection  and  no  communication  al- 
lowed between  passengers  and  the  infected  locality,  should  be 
treated  as  those  in  the  last  paragraph. 

1Upholstered  furniture,  sheepskins  used  as  wearing  apparel,  bedding,  bones, 
horns,  and  hoofs. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  415 

Par.  7.  Prior  to  sailing  from  ports  infected  with  cholera,  each 
passenger  of  the  cabin  class  should  produce  satisfactory  evidence 
as  to  his  exact  place  of  abode  during  the  five  days  immediately 
preceding  embarkation,  and  if  it  appears  that  he  or  his  baggage 
has  been  exposed  to  contagion,  such  passenger  should  be  detained 
such  length  of  time  as  shall  be  deemed  necessary  by  the  inspecting 
officer,  and  the  baggage  should  be  disinfected. 

Par.  8.  The  rules  prescribed  for  the  disinfection  of  the  baggage 
and  personal  effects  of  passengers  and  crew  coming  from  cholera- 
infected  ports  should  also  be  observed  with  regard  to  passengers 
and  crew  coming  from  ports  and  places  where  plague,  yellow 
fever,  typhus  fever,  or  small-pox  is  prevailing  in  an  epidemic  form. 

Par.  9.  Should  cholera  break  out  in  the  barracks  or  houses  in 
which  the  passengers  are  undergoing  the  five  days'  observation,  no 
passenger  from  said  house  or  barracks  should  embark  until  five 
days'  isolation  from  the  last  case  and  a  repetition  of  the  sanitary 
measures  previously  taken. 

Par.  10.  All  baggage  of  steerage  passengers  destined  for  the 
United  States  shall  be  labelled.  If  the  baggage  has  been  inspected 
and  passed,  the  label  shall  be  a  red  label  bearing  the  name  of  the 
port,  the  steamship  on  which  the  baggage  is  to  be  carried,  the 
word  "inspected"  in  large  type,  the  date  of  inspection,  and  the 
seal  or  stamp  of  the  consular  or  medical  officer  of  the  United 
States.  All  baggage  that  has  been  disinfected  shall  bear  a  yellow 
label,  upon  which  shall  be  printed  the  name  of  the  port,  the 
steamship  upon  which  the  baggage  is  to  be  carried,  the  word 
"disinfected"  in  large  type,  the  date  of  disinfection,  and  the  seal 
or  stamp  of  the  consular  or  medical  officer  of  the  United  States. 
It  is  understood,  and  it  will  be  so  printed  on  the  blank,  that  the 
label  is  not  valid  unless  bearing  the  consular  or  medical  officer's 
stamp  or  seal. 

Par.  1 1 .  Each  steerage  passenger  should  be  furnished  with  an 
inspection  card  (see  form  below).  This  card,  stamped  by  the  con- 
sular or  medical  officer,  is  to  be  issued  to  every  member  of  a 
family,  as  well  as  to  the  head  thereof. 

Par.  13.  Cabin  passengers  from  cholera-infected  ports  or  places 
should  be  given  a  special  inspection  card  on  which  shall  be  printed 
the  port  of  departure,  name  of  passenger,  name  of  ship,  date  of 
departure,  and  an  indicated  space  for  the  seal  or  stamp  of  the 
consular  or  medical  officer. 

Par.  14.  The  baggage  of  such  cabin  passengers  shall  be  labelled 
in  the  same  manner  as  steerage  baggage. 

Par.  15.  In  a  port  where  cholera  prevails,  or  where  yellow 
fever  prevails  in  epidemic  form,  the  crews  of  passenger  ships 
should  remain  on  board  during  their  stay.  Should  additional 
men  be  shipped,  the  same  precautions  should  be  observed  with 
them  as  in  the  case  of  steerage  passengers.  If  it  is  considered 
necessary,  the  crews  of  freight  ships  may  be  similarly  treated  at 
the  discretion  of  the  medical  officer. 


4-i6 


QUARANTINE. 


INSPECTION  CARD. 

[Immigrants  and  steerage  passengers.] 

Port  of  departure. Date  of  departure 

Name   of  ship 

Name  of  immigrant- Last  permanent  residence.. 


Inspected  and  passed  at 


[Seal  or  stamp  of  consular 
medical  officer.] 


Passed  at  quarantine,  port  of 
,  United  States. 


[Date.] 


Passed     by     Immigration 
Bureau,  port  of. 


[Date.] 


[The  following  to  be  filled  in  by  ship's  surgeon  or  agent  prior  to  or  after  embarkation] 
Shifl ' s  list  or  manifest. No.  on  skip's  list  or  manifest 


Berth  No. 


6  tx'i 


^  JH  ---    V    p.    <D    j- 


CO    -<*-    ut  vO 


VACCINATED. 

[Signature  or  Stamp.] 
[Reverse  Side.] 

Keep  this  Card  to  avoid  detention  at  Quarantine  and  on  Railroads  in  the 
United  States. 

Diese  Karte  muss  aufbewahrt  werden,  um  Aufenthalt  an  der  Quarantine, 
sowie  auf  den  Eisenbahnen  der  Veieini°;ten  Staaten  zu  vermeiden. 


Cette  carte  doit  etre  conservee  pour  eviter  une  detention  a  la  Quaran- 
taine,  ainsi  que  sur  les  chemins  de  fer  des  Etats-Unis. 


Deze  kaart  moet  bewaard  worden,  ten  einde  oponthoud  aan  de  Quaran- 
tijn,  alsook  op  de  ijzeren  wegen  der  Vereenigde  Staten  te  vermijden. 


Conservate  questo   biglietto   onde   evitare   detenzione   alia  Quarantina   e 
sulle   Ferrovie  deafli  Stati  Uniti. 


Tento  listek  musite  uschovati,  nechcete-li  ukaranteny  (zastaveni  ohledne 
zjisteni  zdravi)  neb  na  draze  ve  spojenych  statech  zdrzeni  byti. 


Tuto  kartocku  treba  trimat'  u  sebe  aby  sa  predeslo  zderzovanu  v  karan- 
tene  aj  na  zeleznici  ve   Spojenych   Statoch. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   417 

Par.  16.  Passengers  and  crews,  merchandise  and  baggage  prior 
to  shipment  at  a  non-infected  port,  but  coming  from  an  infected 
locality,  should  be  subject  to  the  same  restrictions  as  are  imposed 
in  an  infected  port. 

Par.  17.  American  vessels  bound  for  the  United  States,  or  for 
Porto  Rico,  or  for  Cuba,  shall  not  ship  men  in  ports  of  Cuba  or 
Porto  Rico  where  small-pox  or  yellow  fever  prevails,  unless  such 
men  have  been  inspected  and  passed  by  the  quarantine  officer. 

Par.  18.  Passengers  should  not  be  vaccinated  at  nor  en  route 
from  ports  or  places  infected  with  plague.  Such  vaccination  in- 
creases the  liability  to  plague  infection,  and,  by  inducing  fever 
and  swollen  glands,  tends  to  confuse  diagnosis  at  the  port  of 
arrival.  This  operation  must  be  performed  at  the  port  of  arrival, 
and  just  prior  to  release  from  quarantine. 

Article  VI. — Requirements  at  Sea. 

Par.  1.  The  master  of  the  vessel  should  cause  the  following 
rules  (which  comprise  those  recommended  by  the  International 
Conference  of  Rome,  1885)  to  be  observed  during  the  voyage  : 

(a)  The  soiled  body  linen  of  passengers  and  crew  suffering 
from  infectious  disease  should  be  at  once  immersed  in  boiling 
water  or  in  a  disinfecting  solution. 

(b)  The  water-closets  should  be  washed  and  disinfected  twice  a 
day. 

(V)  Rigorous  cleanliness  and  free  ventilation  should  be  main- 
tained during  the  voyage  on  board  all  ships. 

Par.  2.  An  inspection  of  the  vessel,  including  the  steerage, 
should  be  made  by  the  ship's  physician  once  each  day. 

Par.  3.  Should  cholera  (or  cholerine),  yellow  fever,  typhus 
fever,  or  small-pox  appear  on  board  a  ship  while  at  sea,  those  who 
first  show  symptoms  of  these  diseases  will  be  immediately  sent  to 
the  hospital ;  the  ship's  physician  will  then  immediately  notify 
the  captain,  and  all  of  the  effects  liable  to  convey  infection  which 
have  been  in  use  will  be  destroyed  or  disinfected. 

Par.  4.  The  compartments  occupied  by  those  who  fall  sick 
with  infectious  disease  should  be  disinfected,  and,  as  far  as  possi- 
ble, the  compartments  thus  disinfected  should  be  freely  exposed 
to  the  air.  If  the  vessel  is  an  iron  steamer  and  the  compartments 
suitable,  the  entire  compartment  should  be  disinfected  by  steam. 
The  articles  liable  to  convey  infection  should  remain  in  the  com- 
partments during  the  disinfection.  After  disinfection  of  the 
compartments  the  bedding  and  clothing  may  be  removed  and 
dried. 

Par.  5.   Patients  with  infectious  disease  should  be  isolated. 

Par.  6.  The  hospital  should  be  disinfected  as  soon  as  it  becomes 
vacant. 

Par.  7.  The  dead  should  be  enveloped  in  a  sheet  saturated  with 
one  of  the  strong  disinfecting  solutions,  without  previous  washing 

27 


418 


QUARANTINE. 


of  the  body,  and  at  once  placed  in  a  coffin  hermetically  sealed  or 
buried  at  sea. 

Par.  8.  A  clinical  record  should  be  kept  on  the  prescribed 
form,  by  the  ship's  surgeon,  of  all  cases  of  sickness  on  board,  and 
delivered  to  the  quarantine  officer  at  the  port  of  arrival. 

Par.  9.  Under  the  foregoing  paragraphs  disinfecting  solutions 
are  limited  to  the  following  :  Strong  :  acid  solution  of  bichlorid 
of  mercury  (1  :  500)  ;  a  1  :  20  solution  of  pure  carbolic  acid. 
Weak:  acid  solution  of  bichlorid  of  mercury  (1  •  1000);  pure 
carbolic  acid,  1  to  40. 

Par.  10.  (Form  for  clinical  report:)1 


Name. 

Age. 

Sex. 

Date  of 

admission. 

Disease. 

Discharged. 

Result. 

Clinical  history. 

Clinical  history. 

Clinical  history. 

Clinical  history. 

Par.  11.  Sailing  vessels  leaving  ports  infected  with  yellow  fever, 
and  destined  for  any  port  in  the  United  States  south  of  the 
southern  boundary  of  Maryland,  which  is  not  provided  with 
proper  facilities  for  treatment,  shall,  during  the  quarantine  period, 
be  directed  by  the  consular  or  medical  officer  to  proceed  for  dis- 
infection and  treatment  to  some  quarantine  station  in  the  United 
States  provided  with  the  required  facilities. 

1  Temperature  to  be  recorded. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  419 

Article  VII. — Disinfection. 

Par.  1.   The  disinfection  of  iron  vessels  shall  be  as  follows  : 
(a)  Holds. — After  mechanical   cleansing,  the  hold  to  be  thor- 
oughly washed  with  an  acid  solution  of  bichlorid  of  mercury,  1  : 
Soo  (mercury  1  part,  hydrochloric  acid  2  parts,  water  800  parts), 
applied  under  pressure  to  all  surfaces  by  means  of  a  hose. 

IN    CASE    THE    DISINFECTION  IS    REQUIRED    FOR    YELLOW    FEVER. 

If  the  cargo  is  so  stowed  as  to  admit  of  disinfection,  the  hold 
and  cargo  may  be  disinfected  without  breaking  bulk,  by  sulphur 
dioxid,  10  per  cent,  per  volume  strength,  forty-eight  hours' 
exposure  for  iron,  and  seventy-two  hours  for  wooden  vessels. 

(F)  Steerage  and  Forecastle. — The  same  treatment  should  be 
given  the  steerage  and  forecastle  as  the  hold,  but  when  practicable 
steam  disinfection  of  these  compartments  should  be  practised. 
The  temperature  in  all  parts  of  the  compartments  is  to  be  not 
less  than  ioo°  C. 

(e)  Cabins,  Officers'1  Quarters,  State-rooms,  etc. — The  bedding, 
fabrics,  and  carpets  should  be  removed  and  disinfected  by  steam. 
After  thorough  mechanical  cleansing,  the  exposed  surfaces  of 
fabrics,  which  cannot  be  removed,  should  be  washed  with  a  solu- 
tion of  bichlorid  of  mercury,1  1  :  1000,  or  3  per  cent,  solution 
of  carbolic  acid,  both  of  which  should  be  removed,  but  not  under 
two  hours.  Afterward  the  apartments  should  be  thoroughly 
dried  and  aired. 

Par.  2.  The  disinfection  of  wooden  vessels  is  to  be  accom- 
plished as  follows  :  After  mechanical  cleansing,  washing  out  the 
bilges  until  clean,  etc.  (first),  by  fumigation  by  sulphur  dioxid, 
10  per  cent,  strength,  twenty-four  hours  in  the  cabin  and  fore- 
castle and  forty-eight  hours  in  the  hold :  and  (second)  flushing  or 
washing  with  acid  solution  of  bichlorid  of  mercury  in  large 
quantity  (1  :  800).  The  bilges  to  be  first  flushed  with  sea- 
water,  pumped  out,  and  then  treated  with  the  acid  solution  of 
bichlorid  of  mercury  in  large  quantity,  allowed  to  remain  in  long 
contact.  In  addition  to  the  sulphur  fumigation  of  such  apart- 
ments, the  cabins,  forecastle,  and  other  apartments  and  their 
contents,  to  be  treated  as  those  on  iron  vessels. 

CARGO. 

Par.  3.  Disinfection  of  rags  and  old  jute,  etc.,  shall  be  by  one 
of  the  following  methods  : 

(a)  By  boiling  in  water  for  not  less  than  thirty  minutes. 

{¥)  By  steam  at  the  temperature  of  ioo°  C.  for  not  less  than 
thirty  minutes  after  such  temperature  is  reached. 

(r)  By  exposure  for  not  less  than  six  hours  in  a  closed  com- 
partment to  a  4  per  cent,  strength  (per  volume)  of  sulphur  dioxid 

1  Polished  metal  is  injured  by  mercury,  and  leather  by  steam. 


420  QUARANTIXE. 

gas — made  by  burning  roll  sulphur  or  by  the  liberation  of  lique- 
fied sulphur  dioxid — allowance  to  be  made  for  leakage  by  increas- 
ing the  amount  of  sulphur. 

Par.  4.  In  all  of  the  above  methods  the  rags,  old  jute,  etc., 
must  be  unbaled,  and  in  the  disinfection  by  steam  or  sulphur  the 
rags  must  be  loosely  spread  on  racks  (preferably  wire  netting)  in 
layers  of  not  more  than  6  inches  in  depth,  and  in  such  a  manner 
as  to  insure  the  diffusion  of  the  gas  to  all  parts  alike. 

The  articles  must  not  at  any  time  occupy  more  than  50  per 
cent,  of  the  total  cubic  space,  and  the  exposure  to  date  from  the 
complete  combustion  of  the   sulphur. 

Par.  5.  New  feathers  for  bedding  shall  be  disinfected  by  one 
of  the  following  methods  : 

(a)  By  steam  at  a  temperature  of  ioo°  C.  for  a  period  of  thirty 
minutes  after  such  temperature  has  been  reached. 

(b)  By  exposure  to  sulphur  dioxid,  4  per  cent,  strength  per 
volume,  for  not  less  than  six  hours. 

Par.  6.  Human  hair,  or  other  hair,  unmanufactured,  and 
bristles,  to  be  disinfected  by  sulphur  dioxid,  4  per  cent,  strength 
per  volume,  six  hours,  or,  if  not  clean,  by  a  solution  of  pure  car- 
bolic acid,  4  per  cent,  strength,  the  articles  to  be  thoroughly 
saturated. 

Par.  7.  Wool  to  be  disinfected  by  sulphur  dioxid,  4  per  cent. 
strength  per  volume,  for  not  less  than  twenty  hours,  the  wool  to 
be  unbaled  and  loosely  spread  on  racks,  as  in  the  manner  provided 
for  the  disinfection  of  rags. 

Par.  8.  Hides  to  be  disinfected  by  sulphur  dioxid,  4  per  cent, 
strength  per  volume,  for  not  less  than  twenty  hours,  or  by  thorough 
saturation  with  a  solution  of  pure  carbolic  acid,  4  per  cent, 
strength ;  hides  to  be  invariably  unbaled  for  the  purpose. 

Par.  9.  Articles  mentioned  in  paragraph  10,  Article  IV.,  should 
be  disinfected  by  being  spread  on  racks  and  exposed  to  sulphur 
dioxid,  4  per  cent,  per  volume,  twenty  hours. 

Par.  10.   Coverings  should  be  disinfected  : 

(a)  In  the  hold,  by  exposure  to  sulphur  dioxid,  10  per  cent, 
strength  per  volume,  for  twelve  hours  ;  the  cargo  being  so  stowed 
as  to  allow  access  to  all  parts  of  such  surfaces. 

(J>)  By  breaking  bulk  and  exposure  to  sulphur  dioxid,  4  per 
cent,  strength  per  volume  for  twenty-four  hours. 

(V)  By  wetting  thoroughly  with  solution  of  bichlorid  of  mer- 
cury, 1  :  800. 

Par.  11.  The  disinfection  of  personal  effects,  prescribed  by 
these  regulations,  should  be  as  follows : 

(A)  Clothing  and  bedding  should  be  disinfected  by — fi)  Ex- 
posure to  steam  from  ioo°  to  1020  C.  for  thirtv  minutes  after  such 
temperature  is  reached,  or  by  boiling  for  thirtv  minutes.  <  2) 
Immersion  in  bichlorid  solution,  1  :  800,  or  solution  of  pure 
carbolic  acid,  3  per  cent.,  until  thoroughly  wetted  and  allowed 
to  dry  before  washing. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   421 

This  last  process  (2)  to  be  used  only  for  articles  that  will  be 
injured  by  steam  or  boiling.1 

(B)  Cooking  and  eating  utensils  should  be  immersed  in  boiling 
water. 

Note. — A  4  per  cent,  per  volume  strength  of  sulphur  dioxid 
can  be  obtained  by  burning  not  less  than  4  pounds  2  ounces  of 
sulphur  to  each  1000  cubic  feet  of  space  ;  the  compartment  to  be 
air-tight. 

A  10  per  cent,  per  volume  strength  can  only  be  obtained  by 
one  of  the  following  methods  :  By  the  use  of  a  special  furnace  or 
by  liquefied  sulphur  dioxid  gas. 

Article  VIII. — Records,  Reports,  etc. 

The  officer  making  the  inspection  will  preserve  in  his  office  a 
record  of  each  inspection  made.  A  copy  of  said  record  will  be 
forwarded  weekly  to  the  Supervising  Surgeon- General  of  the 
Marine-Hospital  Service  at  Washington,  D.  C. 

In  addition  to  the  duties  already  prescribed,  the  medical  officer, 
when  detailed  in  accordance  with  the  act  of  Congress  approved 
February  15,  1893,  shall  furnish  such  reports  to  the  Supervising 
Surgeon-General  Marine-Hospital  Service  as  may  be  required  by 
the  latter. 

Article  IX. — Regulations  at  Ports  Infected  or  Suspected 
of  being  Infected  with  Plague. 

At  all  foreign  ports  and  places  infected  or  suspected  of  being 
infected  with  plague  the  United  States  Quarantine  Regulations, 
Treasury  Department,  1894,  relating  to  cholera,  shall  be  observed 
with  regard  to  vessels  and  cargoes  bound  to  the  United  States. 
Passengers  and  crews  of  said  vessels  who  have  been  exposed  to 
the  infection,  or  are  liable  to  convey  the  disease,  shall  be  detained 
a  period  of  not  less  than  fifteen  days  from  the  last  possible  ex- 
posure to  infection,  under  the  same  regulations  as  those  relating 
to  cholera. 

Par.  2.  Baggage  labelled  and  sealed  by  the  consul  or  medical 
officer  of  the  Marine-Hospital  Service  at  a  non-infected  city  may 
be  admitted  without  disinfection,  even  though  shipped  through 
an  infected  port  or  locality,  provided  it  arrives  with  the  seal 
unbroken.  Such  baggage  should  be  accompanied  by  a  certificate 
of  origin  and  non-exposure  to  infection. 

Par.  3.  Passengers  coming  from  an  infected  or  suspected 
locality  and  desiring  to  take  passage  at  a  non-infected  port  should 
be  held  fifteen  days  under  observation  before  being  allowed  to 
embark  ;  otherwise  the  ship  and  all  on  board  will  be  considered 
by  the  quarantine  officer  at  the  port  of  arrival  in  the  United 
States  as  coming  from  an  infected  port.     Any  baggage  from  such 

1  Articles  of  rubber,  leather,  celluloid,  gutta-percha,  hats,  furs,  skins,  and 
similar  articles  are  injured  by  steam  or  boiling. 


422  QUARANTINE. 

infected  or  suspected  localities  destined  for  shipment  through  a 
non-infected  port  must  be  disinfected  prior  to  shipment. 

Par.  4.  In  a  port  where  plague  prevails,  the  vessel  should  not 
tie  up  to  the  dock.  No  lines  should  be  passed  to  the  shore  that 
might  permit  rats  to  come  on  board.  Passengers  and  cargo  should 
be  lightered  ;  the  crew  not  be  allowed  ashore,  and  personal  commu- 
nication from  shore  to  vessel  shall  be  under  medical  supervision. 
A  statement  to  this  effect  from  a  medical  officer  of  the  Marine- 
Hospital  Service  will  have  weight  with  the  quarantine  officer  at 
the  port  of  arrival  in  determining  the  questions  of  disinfection 
and  time  of  detention. 

Par.  5.  Mammalian  animals,  such  as  dogs,  cats,  monkeys, 
mice,  etc.,  which  not  infrequently  accompany  passengers  as  pets, 
should  not  be  shipped  from  a  plague-infected  or  suspected  port  or 
place. 

Article   X. — Baggage  and    Effects  from    Cuba  and    Porto 

Rico. 

Par.  1.  During  the  quarantine  close  season,  April  1  to  Novem- 
ber 1,  all  baggage  and  personal  effects,  including  hand  baggage, 
of  passengers  leaving  the  island  of  Cuba  shall  be  labelled  by  the 
quarantine  officer  at  the  port  from  which  the  vessel  sails.  The 
label  shall  bear  either  the  word  "Disinfected,"  or  the  words 
"Inspected  and  passed,"  or  "  Inspected  and  passed  to  northern 
territory." 

Par.  2.  All  said  baggage  or  personal  effects  destined  for  ports 
in  the  United  States  south  of  the  southern  boundary  of  Maryland 
shall  be  disinfected  and  bear  the  "  Disinfected  "  label. 

Baggage  shipped  through  a  southern  port,  but  checked  through 
to  a  point  north  of  the  southern  boundary  of  Maryland,  with 
such  precautions  as  maybe  hereafter  required  to  prevent  its  being 
opened  en  route,  may  be  labelled  "  Inspected  and  passed  for 
northern  territory."  But  any  such  baggage  presumably  infected, 
or  concerning  which  the  quarantine  officer  at  the  Cuban  port  may 
feel  in  doubt,  shall  be  disinfected. 

Par.  3.  All  baggage,  as  above  described,  destined  to  ports  in 
the  United  States  north  of  the  southern  boundary  of  Maryland 
shall  bear  the  label  "Inspected  and  passed"  or  "Disinfected," 
as  the  case  may  be. 

Baggage  or  personal  effects  bound  for  ports  in  the  United  States 
north  of  the  southern  boundary  of  Maryland,  and  whose  ultimate 
destination  is  proved  to  the  satisfaction  of  said  quarantine  officer 
to  be  a  point  north  of  the  southern  boundary  of  Maryland,  and 
not  intended  thereafter  to  be  shipped  to  a  point  south  of  the 
southern  boundary  of  Maryland,  may  be  labelled  "  Inspected  and 
passed. ' ' 

But  if  any  such  baggage  is  presumably  infected,  then,  though 
bound  to  a  northern  port,  it  shall  be  disinfected,  and  any  baggage 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   423 

bound  for  a  northern  port,  concerning  which  the  quarantine 
officer  may  feel  in  doubt,  may  in  his  discretion  be  disinfected. 

Par.  4.  It  is  further  ordered  that  any  baggage  or  personal 
effects  from  the  island  of  Cuba  arriving  at  any  port  in  the  United 
States  during  the  season  of  close  quarantine,  April  1  to  November 
1,  not  labelled  with  either  the  "Inspected"  or  "Disinfected" 
label,  shall  be  disinfected  at  the  quarantine  station  at  the  port  of 
arrival. 

Par.  5.  The  foregoing  regulations  will  apply  also  to  any  port 
in  Porto  Rico,  should  yellow  fever  appear  in  said  port. 

Par.  6.  The  quarantine  officers  in  Cuba  and  Porto  Rico  charged 
with  the  labelling  of  the  baggage,  as  above,  shall  exercise  care  and 
their  discretion  as  to  disinfecting  all  baggage  coming  from  other 
ports  or  interior  places. 

QUARANTINE  REGULATIONS  FOR  DOMESTIC  PORTS 
TO  PREVENT  THE  INTRODUCTION  OF  PLAGUE 
FROM   SANTOS  AND  OPORTO. 

In  view  of  the  officially  reported  prevalence  of  plague  in  San- 
tos, Brazil,  and  Oporto,  Portugal,  and  the  local  conditions  at 
these  ports,  the  following  regulations  relating  to  vessels  arriving 
therefrom  at  ports  of  the  United  States  are  hereby  promulgated. 
This  circular  will  remain  in  force  until  thirty  days  after  the 
official  announcement  of  the  cessation  of  plague  in  said  cities. 
The  regulations  for  domestic  ports  regarding  plague,  promulgated 
by  Department  circular  of  January  18,  1897,  are  embodied  herein 
in  full.  Attention  is  called  to  the  fact  that  all  vessels  from  Santos 
and  Oporto  are  to  be  subjected  to  the  following  requirements  : 

Treatment  of  Vessels  from  Santos  and  Oporto.— 1.  Place 
vessel  in  quarantine  in  anchorage  sufficiently  remote  from  the 
nearest  land  or  other  vessel  to  prevent  the  escape  of  rats  by  swim- 
ming. 

2.  Pilots- bringing  in  vessels  from  these  ports,  if  they  go  aboard 
the  vessel,  will  be  detained  in  quarantine  a  sufficient  time  to  cover 
the  period  of  incubation  of  the  disease,  if  in  the  opinion  of  the 
quarantine  officer  said  pilots  have  been  exposed  to  infection ;  and 
their  dunnage,  if  any,  shall  be  disinfected. 

3.  In  inspecting  vessels  from  these  ports,  the  personnel  of  the 
vessel  shall  be  inspected  after  the  removal  of  all  clothing  which 
will  interfere  with  a  thorough  examination  of  all  glandular  regions, 
including  axillary,  inguinal,  and  cervical. 

4.  Remove  all  passengers  from  the  vessel  and  all  of  the  crew 
save  those  necessary  to  care  for  her.  Place  the  sick,  if  any,  in 
hospital,  and  carefully  isolate  those  specially  suspected.  Segre- 
gate the  remainder  in  small  groups.  No  communication  shall  be 
held  between  these  groups.  Those  believed  to  be  especially 
capable  of  conveying  infection  must  not  enter  the  barracks  (place 
of  detention)  until  they  are  bathed  and   furnished  with  sterile 


424  QUARANTINE. 

clothing  ;  nor  shall  any  material  capable  of  conveying  infection 
be  taken  into  the  barracks,  especially  food  that  may  be  contami- 
nated. 

5.  All  occupants  of  the  steerage  must  be  bathed  and  their 
clothing  disinfected. 

6.  All  baggage,  including  hand  baggage,  and  effects  accom- 
panying steerage  passengers  and  crew,  must  be  disinfected. 

7.  No  article  from  the  vessel  shall  be  admitted  to  the  barracks 
before  the  disinfection  of  said  article. 

8.  Preliminary  Disinfection. — After  removal  of  the  personnel 
as  above,  a  preliminary  disinfection  of  all  accessible  parts  of  the 
vessel  must  be  performed  with  sulphur  dioxid.  This  preliminary 
disinfection  should  be  started  in  the  morning,  in  order  that  a 
water  guard,  in  small  boats,  may  be  placed  around  the  vessel  to 
detect  and  destroy  any  escaping  rats.  (See  Note,  p.  428.)  No 
person  with  an  abrasion  or  open  sore  shall  be  allowed  to  engage 
in  handling  vessel  or  cargo. 

9.  The  water-supply  must  be  changed  without  delay,  the  casks 
or  tanks  disinfected  by  steam  or  10  per  cent,  solution  of  potas- 
sium permanganate,  and,  after  thorough  rinsing,  refilled  from  a 
source  of  undoubted  purity,  or  the  water  supplied  must  have  been 
recently  boiled. 

10.  Nothing  shall  be  thrown  overboard  from  the  vessel,  not 
even  deck  sweepings.  Such  material  shall  be  burned  in  the 
furnace  or  in  a  place  specially  designated,  but  not  in  the  galley. 

Disinfection.- — Disinfection  of  vessels  from  these  ports  shall 
be  as  follows  : 

11.  Disinfection  of  Iron  Vessels. — (a)  With  Cargo. — After 
twelve  hours'  exposure  to  sulphur  dioxid,  10  per  cent,  per  volume 
strength,  generated  by  an  approved  furnace,  or  twenty-four  hours' 
exposure  to  5  per  cent,  per  volume  strength,  generated  by  pots, 
the  upper  four-  to  six-foot  layer  of  cargo  may  be  removed  and 
placed  on  lighters  exposed  to  the  sun ;  this  process  of  disinfection 
and  removal  of  successive  layers  to  be  continued  until  hold  is 
empty. 

12.  Where  it  can  be  procured  in  sufficient  quantity,  liquefied 
sulphur  dioxid  may  be  used  in  the  disinfection  of  cargoes,  holds, 
and  living  apartments,  it  being  borne  in  mind  that  it  will  be 
necessary  to  employ  2  pounds  of  this  material  in  lieu  of  1  pound 
of  sulphur  where  indicated  in  the  above  regulations. 

13.  No  person  shall  be  allowed  on  the  vessel  or  around  the 
cargo  with  bare  feet,  and  the  use  of  gloves  in  handling  the  cargo 
or  dead  vermin  is  advised. 

14.  All  merchandise  placed  on  lighters,  although  covered  with 
tarpaulins  at  night  and  during  foul  weather,  should  be  freely  ex- 
posed to  the  sun  and  air  during  the  day  and  in  good  weather,  for 
one  week. 

15.  (/;)  Without  Cargo. — After  mechanical  cleansing  the  hold 
must  be  thoroughly  washed  with  an  acid  solution  of  bichlorid  of 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   425 

mercury,  1  :  800,  applied  under  pressure  to  all  surfaces  by  means 
of  a  hose,  followed  by  sulphur  dioxid,  10  per  cent,  per  volume 
strength,  for  twenty-four  hours,  or  5  per  cent,  per  volume  strength 
for  forty-eight  hours. 

16.  The  water  ballast  of  a  vessel  coming  from  these  ports 
should  be  discharged  at  sea,  or  if  discharged  in  fresh  or  brackish 
water  must  be  previously  disinfected,  the  tanks  to  be  flushed  and 
refilled  with  sea  water,  or  disinfected. 

17.  Holds  of  Wooden  Vessels. — For  a  wooden  vessel  the  treat- 
ment is  the  same  as  for  iron  vessels,  except  that  the  exposure  of 
the  hold  to  sulphur  dioxid,  10  per  cent,  per  volume  strength, 
must  precede  the  washing  with  bichlorid  in  the  empty  vessel,  and 
this  exposure  must  be  forty-eight  hours  in  wooden  vessels,  without 
cargo,  or  if  only  5  per  cent,  per  volume  strength  sulphur  dioxid 
is  obtainable,  the  exposure  must  be  seventy-two  hours. 

18.  The  disinfection  and  removal  of  cargo  in  layers  shall  be  in 
the  same  manner  as  for  iron  vessels. 

19.  All  solid  ballast  on  vessels  infected,  or  suspected  of  being 
infected,  with  plague,  to  be  discharged  or  disinfected  previous  to 
disinfection  of  hold ;  all  such  ballast  discharged  in  fresh  water  to 
be  disinfected  by  saturation  with,  or  immersion  in,  an  acid  solu- 
tion of  bichlorid  of  mercury,  1  :  800. 

20.  Clear,  hard,  close-grained  rock  may  be  permitted  to  remain 
on  board,  but  only  after  disinfection  by  immersion  in  an  acid 
solution  (1  :  800)  of  bichlorid  of  mercury.  Ballast  removed  from 
vessels  infected,  or  suspected  of  being  infected,  with  plague,  must 
not  be  taken  from  the  quarantine  station. 

21.  Living  Compartments  of  all  Vessels. — These  compartments 
— cabin,  steerage,  and  forecastle — shall  be  treated  by  one  of  the 
following  methods  (a)  or  (/?)  : 

(a)  Twelve  hours'  exposure  to  10  per  cent,  per  volume  strength 
sulphur  dioxid,  or  twenty-four  hours  to  5  per  cent,  per  volume 
strength  of  the  same  gas.  After  period  of  exposure  there  shall 
be  thorough  mechanical  cleansing,  after  which  the  woodwork  and 
all  other  exposed  surfaces  shall  be  washed  with  an  acid  solution 
of  bichlorid  of  mercury,  1  :  1000,  or  a  3  per  cent,  solution  of 
pure  carbolic  acid.  Fabrics  which  cannot  be  removed  shall  be 
thoroughly  saturated  with  a  solution  of  bichlorid  of  mercury, 
1  :  1000,  or  a  3  per  cent,  solution  of  pure  carbolic  acid. 

(a)  After  the  removal  of  the  bedding,  carpets,  and  furnishings, 
all  apertures  being  tightly  closed,  the  steerage,  cabin,  and  fore- 
castle of  a  vessel  may  be  disinfected  by  formaldehyd  gas  of  not 
less  than  2  per  cent,  per  volume  strength,  the  time  of  exposure  to 
be  not  less  than  twelve  hours.  The  gas  may  be  generated  from  a 
mixture  containing  formalin  100  parts,  calcium  chlorid  or  sodium 
nitrate  20  parts,  and  glycerin  10  parts.  The  gas  is  evolved  from 
this  solution  by  heating  it  in  a  special  boiler,  autoclave,  or  formal- 
dehyd generator.  One  liter  of  a  40  per  cent,  solution  of  formal- 
dehyd gas  will  evolve  about  1425  liters  (50.1   cubic  feet)  of  the 


426  QUARANTINE.    , 

gas  at  2o°  C.  (68°  F.),  and  will  be  sufficient  for  71  cubic  meters 
(2505.5  cubic  feet)  of  space.  After  the  disinfection  of  apart- 
ments, steerage,  cabin,  and  forecastle,  by  formaldehyd  gas,  the 
latter  may  be  neutralized  by  ammonia  gas,  evolved  from  water  of 
ammonia  by  heat  or  by  evaporation  from  water  of  ammonia 
sprinkled  on  the  floor. 

Bedding,  fabrics,  and  carpets  must  be  removed  and  disinfected 
in  the  manner  described  for  personal  effects  of  passengers  and 
crew. 

22.  Personal  Effects  of  Passengers  and  Crew. — Clothing,  bed- 
ding, and  other  articles  shall  be  disinfected  by  one  of  the  follow- 
ing methods  : 

{a)  For  articles  not  injured  by  steam,  by  exposure  to  steam  at 
a  temperature  of  ioo°  to  1020  C.  for  thirty  minutes  after  such 
temperature  has  been  reached,  in  a  special  chamber.  Disinfection 
by  steam  is  not  allowed  in  the  hold  or  forecastle. 

(o)  By  boiling  for  fifteen  minutes  all  articles  to  be  submerged. 

(<r)  By  thorough  saturation  in  a  solution  of  bichlorid  of  mer- 
cury, 1  :  1000,  drying  being  allowed  before  washing. 

(d)  Sulphur  fumigation  of  personal  effects,  when  other  methods 
are  unavailable,  may  be  used  in  a  closed  compartment,  with 'ex- 
posure of  twenty-four  hours  if  5  per  cent,  per  volume  strength, 
or  twelve  hours  if  10  per  cent,  per  volume,  is  used. 

(<?)  By  formaldehyd  gas,  used  in  the  ordinary  jacketed  steam 
disinfecting  chamber  when  the  latter  is  provided  with  a  vacuum 
apparatus  and  special  apparatus  for  generating  and  applying  the 
gas.  Following  is  the  method  of  using  formaldehyd  gas  in  the 
steam  chamber : 

23.  Use  of  Formaldehyd  in  Steam  Chamber. — Raise  and  main- 
tain the  temperature  of  the  chamber  at  900  C.  by  the  use  of  steam 
in  the  jacket. 

The  number  of  cubic  centimeters  of  the  formalin  mixture  to  be 
used  may  be  found  by  dividing  the  capacity  of  the  chamber  in 
liters  by  4;  for  example,  a  chamber  of  2500  liters  capacity  would 
require  625  c.c.  of  the  mixture.  The  time  of  exposure  should 
be  not  less  than  thirty  minutes.  Clothing,  bedding,  etc.,  thus  dis- 
infected should  be  exposed  in  situ  to  an  equal  amount  of  ammonia 
gas  generated  by  the  special  apparatus  attached  to  the  chamber, 
using  one-half  as  much  water  of  ammonia  as  formalin.  The 
quantity  of  water  of  ammonia  required  for  neutralization  after 
the  above-named  methods  is  y2  liter  (0.52  quart)  of  water  of 
ammonia  for  each  liter  (1.04  quarts)  of  formalin. 

24.  Cooking  and  eating  utensils  should  be  immersed  in  boiling 
water  or  steam. 

Final  Disposition  of  Vessels — Before  the  vessel  is.  allowed 
to  dock  the  following  precautions  must  be  enforced  : 

25.  After  the  cargo  has  been  discharged  the  vessel  must  be 
submitted  to  disinfection  of  all  parts  simultaneously  by  sulphur 
dioxid  gas  of  5  per  cent,  per  volume  strength  for  not  less  than 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.   427 

twenty-four  hours,  in  order  to  insure  destruction  of  all  animal 
life  aboard.  The  remains  of  all  rats  and  vermin  should  be 
gathered  and  burned,  and  the  place  where  gathered  subsequently 
disinfected  with  bichlorid  solution. 

26.  Rats  must  not  be  handled  with  bare  hands. 

27.  The  vessel  must  be  kept  under  observation  a  sufficient 
length  of  time  to  satisfy  the  quarantine  officer  that  all  vermin  are 
destroyed,  and  a  new  crew  or  a  crew  that  has  passed  the  period 
of  observation  should  be  provided. 

Detention  of  Personnel — 28.  If  practicable,  antipeste  serum 
should  be  used  as  a  preventive  measure  on  all  the  personnel  of 
any  vessel  arriving  with  a  history  of  sickness  of  a  suspicious  char- 
acter on  board  during  the  voyage. 

29.  The  personnel  of  vessel  shall  be  detained  under  observation 
fifteen  days  from  the  last  possible  exposure  to  infection. 

30.  The  people  detained  shall  be  inspected  by  the  physician 
twice  daily,  and  under  his  constant  surveillance,  and  no  inter- 
course will  be  allowed  between  different  groups  while  in  quaran- 
tine. 

31.  No  direct  communication  shall  be  allowed  between  any 
person  detained  in  quarantine  and  any  one  not  in  quarantine, 
except  through  the  quarantine  officer  or,  by  his  order,  through 
his  agents. 

32.  The  water-  and  food-supply  will  be  strictly  guarded  to  pre- 
vent contamination,  and  issued  to  each  group  separately. 

33.  Food  of  a  simple  character  sufficient  in  quantity,  thoroughly 
cooked,  shall  be  issued  to  those  detained  in  quarantine. 

34.  Cleanliness  of  quarters  and  of  persons  shall  be  enjoined 
and  enforced  daily.  Disinfection  shall  be  used  where  there  is 
any  possibility  of  infection. 

35.  Water-closets,  urinals,  privies,  or  troughs  shall  be  provided, 
and  their  contents  disinfected  before  they  are  discharged. 

36.  In  any  group  in  which  plague  appears  the  sick  will  be  im- 
mediately isolated  in  hospital,  and  the  remaining  persons  in  the 
group  shall  be  bathed  and  their  effects  be  disinfected,  then  re- 
moved to  other  quarters  if  possible,  and  the  compartment  disin- 
fected. 

37.  No  direct  communication  shall  be  allowed  between  the 
physician  and  attendants  of  the  hospital  and  those  detained  in 
quarantine  in  barracks. 

38.  No  persons  shall  be  discharged  from  quarantine  until  fifteen 
days  have  elapsed  since  the  last  exposure  to  infection  and  a  final 
disinfection  of  such  effects  as  were  taken  to  barracks. 

39.  No  convalescent  from  plague  shall  be  discharged  from 
quarantine  until  after  a  sufficient  time  has  elapsed  to  insure  his 
freedom  from  infection. 

40.  The  body  of  no  person  dead  of  plague  shall  be  allowed  to 
pass  through  quarantine.  The  body  should  be  cremated  if  prac- 
ticable.     If  not,  it  should  be  wrapped,  without  preliminary  wash- 


428  QUARANTINE. 

ing,  in  a  sheet  saturated  with  a  solution  of  bichlorid  of  mercury, 
i  :  500,  and  buried,  surrounded  by  caustic  lime. 

Note. — Officers  of  the  Marine- Hospital  Service  at  national  quarantine 
stations  state  that  it  is  not  uncommon  on  wooden  vessels,  especially  those 
recently  engaged  in  the  grain  trade,  to  gather  up,  after  disinfection  of  the  hold 
■with  sulphur,  a  washtub  full  of  dead  rats ;  generally  from  alongside  the  keelson, 
where  they  have  apparently  gone  to  avoid  the  fumes  of  the  sulphur,  which  rise 
while  hot  and  sink  upon  cooling. 

In  using  the  pot  plan  of  disinfection  it  is  customary  to  place  the  pots  between 
decks  or,  where  there  is  only  one  deck,  to  elevate  the  pots  on  piled-up  ballast, 
allowing  the  fumes  while  hot  to  reach  the  upper  part  of  the  hold  and,  as  they 
cool,  to  sink,  thus  avoiding  the  checking  of  the  fire  in  the  pot  until  the  maximum 
amount  of  sulphur  may  be  burned. 

So  far  as  present  knowledge  goes,  the  most  available  method  of  killing  rats 
in  any  ship  is  by  sulphur  fumes,  and  this  may  be  done  with  reasonable  certainty 
if  the  quantity  of  sulphur  burned  and  the  period  of  exposure  to  the  gas  com- 
ply with  the  present  United  States  quarantine  regulations,  which,  stated  briefly, 
are  as  follows : 

Four  and  one-half  pounds  of  sulphur  burned  in  an  iron  pot  to  each  1000 
cubic  feet  of  space  for  both  wooden  and  iron  vessels,  the  period  of  exposure  to 
the  fumes  to  be  in  the  case  of  wooden  vessels,  empty,  forty-eight  hours ;  iron 
vessels,  empty,  twenty-four  hours ;  wooden  vessels,  with  cargo,  seventy-two 
hours ;   iron  vessels,  with  cargo,  twenty-four  hours. 

Generally  speaking,  when  gas  is  generated  in  10  per  cent,  per  volume  by  a 
specially  devised  furnace,  one-half  the  exposure  above  stated  will  be  sufficient 
to  accomplish  the  results  desired. 

NOTES    FOR    THE    INFORMATION    OF    MASTERS    OF    VESSELS 
AND   OTHERS. 

FORMULAE   FOR    STRONG   DISINFECTING    SOLUTIONS. 

Bichlorid  of  Mercury  (7  :joo). 

Bichlorid  of  mercury I  part. 

Hydrochloric  acid 2  parts. 

Water 500      " 

Mix. 

Carbolic  Acid. 

Carbolic  acid  (pure) 50  parts. 

Warm  water 1000      " 

FORMULAE   FOR    WEAK    SOLUTIONS. 
Bichlorid  of  Mercury  {/  :  1000  ) . 

Bichlorid  of  mercury I  part. 

Hydrochloric  acid 2  parts. 

Water 1000      " 

Carbolic  Acid. 

Carbolic  acid  (pure) 25  parts. 

Warm  water IOOO      " 

DISINFECTION    OF    HOSPITALS,    INFECTED    COMPARTMENTS,    ETC. 

(a)  By  steam,  as  provided  in  Article  VII.,  paragraph  (c)  ;  or, 
when  steam  is  not  available — 


QUARANTINE  LA  WS  OF  THE  UNITED  STA  TES.  429 

{_&)  By  methods  prescribed  in  Article  VII.,  paragraphs  (a) 
and  (V). 

Water-closets,  etc.,  should  be  disinfected  by  strong  solution  of 
bichlorid  of  mercury  or  carbolic  acid.1 

It  is  suggested  that  a  vessel  should  carry  for  every  100  passen- 
gers:  Bichlorid  of  mercury,  5  pounds;  hydrochloric  acid,  10 
pounds;  carbolic  acid,    10  pounds. 

QUARANTINE  REGULATIONS  TO  BE  OBSERVED  AT 
PORTS  AND  ON  THE  FRONTIERS  OF  THE  UNITED 
STATES. 

PREAMBLE. 

Par.  1.  At  or  convenient  to  the  principal  ports  of  the  United 
States  quarantine  stations  should  be  equipped  with  all  appliances 
for  the  inspection  and  treatment  of  vessels,  their  passengers, 
crews,  and  cargoes. 

Par.  2.  At  all  other  ports  where  such  provisions  have  not  been 
made  inspection  stations  should  be  maintained. 

Par.  3.  An  inspection  service  should  be  maintained  at  every 
port  throughout  the  year. 

Par.  4.  At  a  fully  equipped  quarantine  station  there  should  be 
adequate  provision  for  boarding  and  inspection,  apparatus  for 
mechanical  cleaning  of  vessels,  apparatus  for  steam  disinfection, 
apparatus  for  disinfection  with  sulphur  dioxid,  apparatus  for  dis- 
infecting solutions,  hospitals  for  contagious  and  doubtful  cases, 
detention  barracks  for  suspects,  bathing  facilities,  crematory,  and 
sufficient  supply  of  good  water. 

Par.  5.  The  personnel  of  quarantine  stations  in  the  yellow- 
fever  zone  and  on  fruiters  bound  for  southern  ports  should  be 
immune  against  yellow  fever. 

Par.  6.  At  quarantine  stations  all  articles  liable  to  convey 
infection  should  be  handled  only  by  the  employes  of  said  station, 
unless  the  services  of  the  crew  are  indispensable. 

Par.  7.  Vessels  having  been  treated  at  national  quarantine 
stations  that  are  located  a  considerable  distance  from  the  ports  of 
entry  of  said  vessels  may  be  inspected  by  the  local  quarantine 
officer,  and  if  for  any  sanitary  reason  it  is  considered  inadvisable 
to  admit  the  vessel  he  should  report  the  facts  immediatelv,  by 
telegraph  when  possible,  to  the  Supervising  Surgeon-General, 
Marine-Hospital  Service,  detaining  the  vessel  pending  his  action. 

Par.  8.  The  following  regulations  are  the  required  minimum 
standard,  and  do  not  prevent  the  addition  of  such  other  rules  as, 
for  special  reasons,  may  be  legally  made  by  State  or  local  authorities. 

1  The  use  of  these  disinfecting  solutions  does  not  preclude  the  additional  use 
of  hypochlorite  of  lime. 


430  QUARANTINE. 

Article  I. — Inspection. 

Par.  i.  Vessels  arriving  at  ports  of  the  United  States  under  the 
following  conditions  shall  be  inspected  by  a  quarantine  officer 
prior  to  entry  : 

A.  Any  vessel  with  sickness  on  board. 

B.  All  vessels  from  foreign  ports. 

C.  Vessels  from  domestic  ports  where  cholera  or  yellow  fever 
prevails,  or  where  small-pox  or  typhus  fever  prevails  in  epidemic 
form. 

Exceptions. — Vessels  not  carrying  passengers  on  inland  waters 
of  the  United  States.  Vessels  from  the  Pacific  and  Atlantic  coasts 
of  British  America,  provided  they  do  not  carry  persons  or  effects 
of  persons  non-resident  in  America  for  the  sixty  days  next  pre- 
ceding arrival,  and  provided  always  that  the  port  of  departure  be 
free  from  quarantinable  disease.  Vessels  from  other  foreign  ports 
via  these  excepted  ports  shall  be  inspected. 

D.  Vessels  from  foreign  ports  carrying  passengers  having 
entered  a  port  of  the  United  States  without  complete  discharge  of 
passengers  and  cargo.  Such  vessel  shall  be  subject  to  a  second 
inspection  before  entering  any  other  port.  Vessels  from  ports 
suspected  of  infection  with  yellow  fever,  having  entered  a  port 
north  of  the  southern  boundary  of  Maryland  without  disinfection, 
shall  be  subjected  to  a  second  inspection  before  entering  any 
ports  south  of  said  latitude  during  the  quarantine  season  of  such 
port. 

Par.  2.  The  inspections  of  vessels  required  by  these  regula- 
tions shall  be  made  by  daylight,  except  in  case  of  vessels  in 
distress. 

Par.  3.  Quarantine  regulations  to  be  observed  at  ports  and  on 
the  frontiers  of  the  United  States  are  amended  to  read  as  follows  : 
In  making  the  inspection  of  a  vessel,  the  bill  of  health  and 
clinical  record  of  all  cases  treated  during  the  voyage,  crew  and 
passengers'  lists  and  manifests,  and,  when  necessary,  the  ships' 
log  shall  be  examined.  The  crew  and  passengers  shall  be  mus- 
tered and  examined,  and  compared  with  the  lists  and  manifests, 
and  any  discrepancies  investigated.  When  a  freight  manifest 
shows  that  rags  and  other  articles  of  this  class  are  carried  by  the 
vessel,  a  certificate  of  disinfection,  signed  by  a  United  States 
consul  or  a  medical  officer  of  the  United  States,  shall  be  exhibited 
and  compared  with  same. 

If  no  certificate  of  disinfection  is  produced,  the  collector  of 
customs  at  the  port  of  entry  shall  be  notified  of  same  by  the 
quarantine  officer.  The  collector  of  customs  shall  then  hold  such 
consignment  in  a  designated  place  separate  from  other  freight 
pending  the  arrival  of  the  certificate  of  disinfection  ;  and  in  the 
event  of  its  non-arrival  the  articles  shall  be  disinfected. as  herein- 
before prescribed,  or  shall  be  returned  by  the  common  carrier 
conveying  same. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  431 

Par.  4.  No  person  except  the  quarantine  officer,  his  employes, 
United  States  customs  officers,  or  agents  of  the  vessel  shall  be 
permitted  to  board  any  vessel  subject  to  quarantine  inspection 
until  after  the  vessel  has  been  inspected  by  the  quarantine  officer 
and  given  its  discharge. 

Par.  5.  Tugboats  or  any  other  vessels  having  had  communica- 
tion with  vessels  subject  to  inspection  shall  be  themselves  subject 
to  inspection. 

Par.  6.  After  arrival  at  a  quarantine  station  of  a  vessel  upon 
which  there  appears  or  has  appeared  during  the  last  voyage  a  case 
of  cholera,  small-pox,  typhus  fever,  or  plague,  and  after  quaran- 
tine measures  provided  by  regulations  of  the  Treasury  Department 
have  been  enforced  and  the  vessel  given  free  pratique,  it  is  hereby 
ordered  that  notification  of  the  above-mentioned  facts  be  trans- 
mitted by  the  quarantine  officer  to  the  Commissioner  of  Immigra- 
tion at  the  port  of  arrival,  whose  duty  it  shall  then  be  to  transmit, 
by  mail  or  telegraph,  to  the  State  health  authorities  of  the  several 
States  to  which  immigrants  from  said  vessel  are  destined,  the  date 
of  departure,  route,  number  of  immigrants,  and  the  point  of  des- 
tination in  the  respective  States  of  the  immigrants  from  said 
vessel,  together  with  the  statement  that  said  immigrants  are  from 
a  vessel  which  has  been  subject  to  quarantine  by  reason  of  infec- 
tious disease,  naming  the  disease. 

This  information  is  furnished  to  State  health  officers  for  the  pur- 
pose of  enabling  them  to  maintain  such  surveillance  over  the 
arriving  immigrants  as  they  may  deem  necessary. 

Par.  7.  Baggage  and  effects  arriving  at  ports  of  the  United 
States  from  ports  in  Cuba  and  Porto  Rico  shall  be  treated  in 
accordance  with  the  provisions  of  paragraphs  1  to  6,  inclusive,  of 
Article  X.,  of  the  regulations  to  be  observed  at  foreign  ports  and 
at  sea.  Any  baggage  or  personal  effects  from  the  island  of  Cuba 
arriving  at  any  port  in  the  United  States  during  the  season  of 
close  quarantine,  April  1  to  November  1,  not  labelled  with  either 
the  "inspected"  or  '•'disinfected"  label,  shall  be  disinfected  at 
the  quarantine  station  at  the  port  of  arrival. 

Par.  8.   Inspection  for  plague. 

(a)  In  the  case  of  vessels  infected  or  suspected  of  being  infected 
with  plague,  place  vessel  in  quarantine  in  anchorage  sufficiently 
remote  from  the  nearest  land  or  other  vessel  to  prevent  the  escape 
of  rats  by  swimming. 

(ft)  Pilots,  customs  officials,  agents  of  vessels,  or  others  who  go 
aboard  vessel,  may  be  deemed  and  be  treated  as  a  part  of  the  per- 
sonnel of  the  vessel.  Such  persons  shall  be  detained  in  quaran- 
tine a  sufficient  time  to  cover  the  period  of  incubation  of  the  dis- 
ease, if  in  the  opinion  of  the  quarantine  officer  said  persons  have 
been  exposed  to  infection ;  and  their  dunnage,  if  any,  shall  be 
disinfected. 

(c)  Female  inspectors  should  be  provided  for  inspection  of 
female  personnel.     They  shall  be  instructed  by  the  quarantine 


432  QUARANTINE. 

officer  in  the  general  symptomatology  and  recognition  of  the  dis- 
ease, but  final  decision  is  to  be  made  by  the  quarantine  officer. 

(d)  Special  attention  shall  be  given  to  the  detection  of  ambu- 
lant, or  walking,  cases,  which  are  a  source  of  great  danger  and 
apt  to  be  overlooked  because  they  present  few  objective  signs  to 
attract  attention. 

(e)  Special  attention  should  be  directed  to  the  pneumonic 
type  of  the  disease.  Any  person  presenting  pulmonic  symptoms 
of  rapid  course,  with  or  without  glandular  enlargement,  should  be 
the  subject  of  special  inquiry,  and,  if  possible,  of  bacteriologic 
examination. 

(/)  In  suspected  cases  specimens  of  pus,  sputum,  or  the  con- 
tents of  lymphatic  glands  may  be  sent  to  the  hygienic  laboratory 
of  the  Marine-Hospital  Service  at  Washington,  for  examination 
under  the  precautions  prescribed  by  the  postal  regulations  of  the 
United  States. 

{£)  The  quarantine  officer  at  the  port  of  entry  will  carefully 
examine  the  ship's  manifest  of  cargo  for  household  goods,  bed- 
ding, second-hand  articles,  personal  baggage,  corpses,  rags,  and 
articles  apt  to  carry  infection.  Any  articles  believed  by  the 
quarantine  officer  to  be  infected  must  be  disinfected  in  accordance 
with  the  quarantine  regulations  of  the  United  States. 

Article  II. — Quarantine. 

Par.  i.  For  the  purpose  of  these  regulations,  the  quarantinable 
diseases  are  cholera  (cholerine),  yellow  fever,  small-pox,  typhus 
fever,  leprosy,  and  plague. 

Par.  2.  Vessels  arriving  under  the  following  conditions  shall 
be  placed  in  quarantine  : 

A.  With  quarantinable  disease  on  board. 

B.  Having  had  such  on  board  during  the  voyage  or  within 
thirty  days  next  preceding  arrival ;  or,  if  arriving  in  the  quar- 
antine season,  having  had  yellow  fever  on  board  after  March  i 
of  the  current  year,  unless  satisfactorily  disinfected  thereafter. 

C.  From  ports  infected  with  cholera,  or  where  typhus  fever 
prevails  in  epidemic  form,  coming  directly  or  via  another  foreign 
port,  or  via  United  States  ports,  unless  they  have  complied  with 
the  United  States  quarantine  regulations  for  foreign  ports  ;  also 
vessels  from  non-infected  ports,  but  bringing  persons  or  cargo 
from  places  infected  with  cholera,  yellow  fever,  or  where  typhus 
fever  prevails  in  epidemic  form,  except  as  subsequently  noted. 

D.  From  ports  where  yellow  fever  prevails,  unless  disinfected 
in  accordance  with  these  regulations,  and  not  less  than  five  days 
have  elapsed  since  such  disinfection. 

E.  Tugboats  and  other  vessels  having  had  communication  with 
vessels  subject  to  quarantine  shall  be  quarantined  if  they  have  been 
exposed  to  infection. 

Exceptions. — The  following  exceptions  may  be  made  to  Rules- 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  433 

C  and  D  with  regard  to  vessels  from  ports   quarantined  against  on 
account  of  yellow  fever  : 

(i)  Vessels  arriving  during  certain  seasons  of  the  year,  to  wit, 
from  November  i  to  April  i,  may  be  admitted  to  entry. 

(2)  Vessels  bound  for  ports  in  the  United  States  north  of  the 
southern  boundary  of  Maryland,  with  good  sanitary  condition 
and  history,  having  had  no  sickness  on  board  at  ports  of  depart- 
ure en  route  or  on  arrival,  provided  they  have  been  five  days  from 
last  infected  or  suspected  port,  may  be  allowed  entry  at  port  of 
destination.  But  if  said  vessels  carry  passengers  destined  for 
places  south  of  this  latitude,  the  baggage  of  said  passengers  shall 
be  disinfected. 

In  making  an  inspection  of  a  vessel,  if  from  a  port  where 
yellow  fever  prevails,  and  between  April  1  and  November  1  of 
any  year,  the  inspector  shall  ascertain  the  destination  of  each 
passenger  thereon,  and  if  bound  for  places  south  of  the  southern 
boundary  of  Maryland,  the  baggage  of  such  passenger  shall  be  dis- 
infected according  to  the  rules  for  such  articles  infected  with 
yellow  fever.     Such  baggage  shall  be  labelled. 

(3)  Vessels  engaged  in  the  fruit  trade  from  ports  declared  safe 
for  this  purpose  by  the  Supervising  Surgeon- General  Marine- 
Hospital  Service  may  be  admitted  to  entry  without  detention, 
provided  that  they  carry  no  passengers  and  have  carried  no  pas- 
sengers from  one  port  to  another,  and  have  no  household  effects 
or  personal  baggage  in  cargo,  and  have  complied  with  the  special 
rules  and  regulations  made  by  the  Secretary  of  the  Treasury  with 
regard  to  vessels  engaged  in  said  trade. 

Par.  3.  When  a  vessel  arrives  having  had  small-pox  on  board, 
all  persons  must  submit  to  vaccination,  or  show  satisfactory  evi- 
dence of  recent  vaccination  or  of  having  had  small-pox,  or  be 
detained  in  quarantine  for  not  less  than  fourteen  days. 

Those  who  have  been  directly  exposed  to  the  infection  and 
who  are  not  protected  by  having  had  the  disease  or  by  previous 
successful  vaccination  shall  be  detained  under  observation  for 
fourteen  days  subsequent  to  last  exposure.  All  effects  and  com- 
partments liable  to  convey  infection  must  be  disinfected. 

Par.  4.  On  all  vessels  arriving,  all  passengers  occupying  apart- 
ments other  than  first  or  second  cabin  shall  be  vaccinated  prior 
to  entry,  unless  they  can  show  that  they  have  had  small-pox,  or 
have  been  recently  successfully  vaccinated,  or  be  detained  in 
quarantine  fourteen  days. 

Par.  5.  Vessels  arriving  at  quarantine  with  leprosy  on  board 
shall  not  be  granted  pratique  until  the  leper  with  his  or  her  bag- 
gage has  been  removed  from  the  vessel  to  the  quarantine  station. 

No  case  of  leprosy  will  be  landed. 

If  the  leper  is  an  alien  passenger  and  the  vessel  is  from  a  foreign 
port,  action  will  be  taken  as  provided  by  the  immigration  laws  and 
regulations  of  the  United  States. 

If  the  leper  is  an  alien  and  a  member  of  the  crew,  and  the  vessel 

28 


434  QUARANTINE. 

is  from  a  foreign  port,  said  leper  shall  be  detained  at  the  quaran- 
tine at  the  vessel's  expense  until  taken  aboard  by  the  same  vessel 
when  outward  bound. 

Article  III. — General  Requirements  at  Quarantines. 

Par.  i.  Pilots  bringing  infected  vessels  will  be  detained  in 
quarantine  a  sufficient  time  to  cover  the  period  of  incubation  of 
the  disease  for  which  the  vessel  is  quarantined,  if  in  the  opinion 
of  the  quarantine  officer  such  pilots  have  been  exposed  to  infec- 
tion.    The  dunnage  of  pilots  shall  be  disinfected  when  necessary. 

Par.  2.  No  direct  communication  shall  be  allowed  between 
quarantine  or  any  vessel  in  quarantine  and  any  person  or  place 
outside,  and  no  communication  except  under  the  supervision  of 
the  quarantine  officer. 

Par.  3.  No  ballast  shall  be  allowed  to  leave  the  quarantine 
station  unless  disinfected. 

Par.  4.  Where  it  is  impossible  to  disinfect  cargo  in  situ,  it  shall 
be  removed  and  disinfected  in  the  manner  provided  for  articles  of 
their  class  in  these  regulations  ;  such  articles  to  be  unpacked  and 
so  arranged  as  to  allow  the  disinfectant  used  to  reach  every  part 
of  all  surfaces  of  said  articles. 

Par.  5.  Vessels  arriving  at  any  port  of  the  United  States  having 
cholera  or  yellow  fever  aboard  during  the  quarantine  season  shall 
be  remanded  to  an  anchorage  set  apart  for  infected  vessels,  and 
there  to  remain  until  after  the  discharge  of  the  passengers  and 
purification  of  the  vessel. 

Par.  6.  All  passenger  baggage  disinfected  under  the  require- 
ments of  these  regulations  shall  be  labelled. 

Par.  7.  All  bedding  provided  for  steerage  passengers  must  be 
destroyed  or  be  disinfected  before  being  landed.  Bedticking  or 
other  covering  of  mattresses  and  pillows  used  by  passengers  or 
crew  shall  not  be  landed  unless  disinfected  at  the  quarantine  station 
in  accordance  with  these  regulations,  and  tagged  with  labels  certi- 
fying to  said  disinfection. 

Article  IV. — Treatment  in  Quarantine  of  Cholera-infected 

Vessels. 

Par.  1.  Remove  all  passengers  from  the  vessel  and  all  of  the 
crew  (if  cholera  has  occurred  on  board)  save  those  necessary  to 
care  for  her.1  Place  the  sick  in  hospital  and  carefully  isolate  those 
specially  suspected.  Segregate  the  remainder  in  small  groups.  No 
communication  shall  be  held  between  these  groups.  Those  be- 
lieved to  be  especially  capable  of  conveying  infection  must  not 
enter  the  barracks  until  they  are  bathed  and  furnished  Avith 
sterile  clothing ;  nor  shall  any  material  capable  of  conveying  in- 
fection be  taken  into  the  barracks,  especially  food. 

1  It  is  required  only  if  cholera  has  occurred  on  board. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  435 

Par.  2.  If  cholera  has  occurred  in  the  steerage,  all  occupants 
thereof  must  be  bathed  and  their  clothing  disinfected. 

Par.  3.  At  once  proceed  with  the  disinfection  of  the  hand 
baggage. 

Par.  4.  All  baggage  and  effects  accompanying  steerage  passen- 
gers, and  other  baggage  or  effects  that  may  have  been  exposed  to 
infection,  must  be  disinfected. 

Par.  5.  Such  articles  of  cargo  as  are  liable  to  convey  infection 
must  be  disinfected. 

Par.  6.  All  living  apartments  and  furniture,  and  such  other  por- 
tions of  a  vessel  as  are  liable  to  convey  infection,  shall  be  disin- 
fected. 

Par.  7.  On  cholera-infected  vessels  the  water-supply  must  be 
changed  without  delay,  the  casks  or  tanks  disinfected  by  steam  or 
10  per  cent,  solution  of  potassium  permanganate,  and  after 
thorough  rinsing  refilled  from  a  source  of  undoubted  purity,  or 
the  water  supplied  must  have  been  recently  boiled. 

Par.  8.  Nothing  shall  be  thrown  overboard  from  a  cholera- 
infected  vessel — not  even  deck-sweepings.  Such  things  shall  be 
burned  in  the  furnace  or  in  a  place  specially  designated,  but  not 
in  the  galley. 

Article  V. — Disinfection,  etc. 

Par.  1.  Holds. — The  disinfection  of  iron  vessels  shall  be  as 
follows : 

(a)  With  cargo  :  If  cargo  is  so  stowed  as  to  admit  of  disinfec- 
tion, it  and  the  hold  may  be  disinfected  without  breaking  bulk, 
except  to  such  a  degree  as  to  make  disinfection  practicable,  by 
sulphur  dioxid,  10  per  cent,  per  volume  strength,  for  not  less  than 
twenty-four  hours'  exposure. 

(U)  Without  cargo :  After  mechanical  cleansing  the  hold  (1)  to 
be  thoroughly  washed  with  an  acid  solution  of  bichlorid  of  mer- 
cury, 1  :  800  (mercury  1  part,  hydrochloric  acid  2  parts,  water 
800  parts),  applied  under  pressure  to  all  surfaces  by  means  of  a 
hose;  (1)  by  sulphur  dioxid,  10  per  cent,  per  volume  strength, 
for  twenty-four  hours. 

Par.  2.   Steerage  and  Forecastle. — When  possible  to  obtain  it, 

(ci)  The  steerage  and  forecastle  shall  be  disinfected  by  steam ; 
the  temperature  in  all  parts  of  these  compartments  to  be  not  less 
than  ioo°  C.  for  not  less  than  thirty  minutes  after  such  temper- 
ature has  been  reached. 

(F)  When  steam  cannot  be  obtained  these  compartments  shall 
be  treated  in  the  same  manner  as  required  in  the  disinfection  of 
the  empty  hold. 

Par.  3.  All  beddings  and  furnishings  of  the  steerage  and  fore- 
castle to  be  left  in  place  during  the  disinfection  by  steam. 

If  steam  disinfection  of  steerage  is  not  used,  such  articles  must 
be  removed  under  the  strictest  sanitary  precautions  for  disinfection 
by  steam  or  burning. 


436  QUARANTINE. 

Par.  4.  The  bedding,  fabrics,  and  carpets  should  be  removed 
and  disinfected  by  steam  or  by  boiling.  After  thorough  mechan- 
ical cleansing  the  woodwork  and  all  other  exposed  surfaces  shall 
be  washed  with  an  acid  solution  of  bichlorid  of  mercury,  1  :  1000, 
or  a  3  per  cent,  solution  of  pure  carbolic  acid.  Fabrics  which 
cannot  be  removed  shall  be  thoroughly  saturated  with  a  solution 
of  bichlorid  of  mercury,  1  :  1000,  or  a  3  per  cent,  solution  of  pure 
carbolic  acid. 

Par.  5 .  The  water  ballast  of  a  vessel  coming  from  a  cholera- 
infected  port  should  be  discharged  at  sea,  or,  if  discharged  in 
fresh  or  brackish  water,  must  be  previously  disinfected.  The 
tanks  to  be  flushed  and  refilled  with  sea-water  or  disin- 
fected. 

Par.  6.  For  a  wooden  vessel  the  treatment  is  as  above,  except 
that  exposure  of  the  hold  and  living  apartments  to  sulphur  dioxid, 
10  per  cent,  volume,  must  precede  the  other  treatment.  This 
exposure  must  be,  for  the  hold,  forty-eight  hours,  and  for  living 
apartments  twelve  hours. 

Par.  7.  All  solid  ballast,  on  vessels  infected  with,  or  suspected 
of  being  infected  with,  cholera,  to  be  discharged  or  disinfected 
previous  to  disinfection  of  hold ;  all  such  ballast  discharged  in 
fresh  water  to  be  disinfected  by  saturation  with,  or  immersion  in, 
an  acid  solution  of  bichlorid  of  mercury,  1  :  800. 

Clear,  hard,  close-grained  rock  may  be  permitted  to  remain  on 
board,  but  only  after  disinfection  by  immersion  in  an  acid  solution, 
1  :  800,  of  bichlorid  of  mercury.  Ballast  removed  from  vessels 
infected  with,  or  suspected  of  being  infected  with,  cholera,  must 
not  be  taken  from  the  quarantine  station. 

Par.  8.  Disinfection  of  Steerage,  Forecastle,  and  Cabin  of  Ves- 
sels by  Formaldehyd  Gas. — After  the  removal  of  the  bedding, 
carpets,  and  furnishings,  all  apertures  being  tightly  closed,  the 
steerage,  forecastle,  and  cabin  of  a  vessel  may  be  disinfected 
by  formaldehyd  gas  in  a  percentage  of  not  less  than  2  per  cent, 
per  volume  strength,  the  time  of  exposure  to  be  not  less  than 
twelve  hours.  The  gas  may  be  generated  by  one  of  the  following 
methods : 

(a)  From  a  mixture  containing  formalin  100  parts,  calcium 
chlorid  or  sodium  nitrate  20  parts,  and  glycerin  10  parts. 

The  gas  is  evolved  from  this  solution  by  heating  it  in  a  special 
boiler,  autoclave,  or  formaldehyd  generator. 

One  liter  of  a  40  per  cent,  solution  of  formaldehyd  gas  will 
evolve  about  1425  liters  (50.1  cubic  feet)  of  the  gas  at  200  C. 
(68°  F.),  and  will  be  sufficient  for  71  cubic  meters  (2505.5  cubic 
feet)  of  space. 

(b)  From  the  substance  known  as  trioxymethylene,  by  means  of 
a  special  lamp,  not  less  than  2  grams  (30  grains)  to  be  used  for 
each  cubic  meter  (35.29  cubic  feet)  of  space. 

After  the  disinfection  of  apartments  (steerage,  cabin,  and  fore- 
castle)  by   formaldehyd   gas,    the   latter  may  be  neutralized  by 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.    437 

ammonia  gas,  evolved  from  water  of  ammonia  by  heat,  or  by 
evaporation  from  water  of  ammonia 1  sprinkled  upon  the  floor. 

Par.  9.  Disinfection  of  Clothing,  Bedding,  Upholstered  Furni- 
ture, Articles  of  Leather,  etc.,  by  Formaldehyd  Gas. — These  may 
be  disinfected  by  formaldehyd  gas  in  the  ordinary  jacketed  steam- 
disinfecting  chamber,  the  latter  to  be  provided  with  a  vacuum 
apparatus  and  special  apparatus  for  generating  and  applying  the 
gas. 

Raise  and  maintain  the  temperature  of  the  chamber  at  900  C. 
by  the  use  of  steam  in  the  jacket. 

The  number  of  cubic  centimeters  of  the  formalin  mixture  to  be 
used  may  be  found  by  dividing  the  capacity  of  the  chamber  in 
liters  by  4 ;  e.  g.,  a  chamber  of  2500  liters  capacity  would  require 
625  c.c.  of  the  mixture.  The  time  of  exposure  should  not  be 
less  than  thirty  minutes.  Clothing,  bedding,  etc.,  thus  disin- 
fected, should  be  exposed  in  situ  to  equal  amount  of  ammonia 
gas  generated  by  the  special  apparatus 2  attached  to  the  chamber, 
using  one-half  as  much  water  of  ammonia  as  formalin. 

Article    VI. — Detention    of    Passengers    on    Account    of 

Cholera. 

Par.  1.  The  people  detained  shall  be  inspected  by  the  physician 
twice  daily,  and  be  under  his  constant  surveillance,  and  no  inter- 
course will  be  allowed  between  different  groups  while  in  quarantine. 

Par.  2.  No  direct  communication  shall  be  allowed  between  any 
person  detained  in  quarantine  and  any  one  not  in  quarantine, 
except  through  the  quarantine  officer  or,  by  his  order,  through  his 
agents. 

Par.  3.  The  water-  and  food-supply  will  be  strictly  guarded  to- 
prevent  contamination,  and  issued  to  each  group  separately. 

Par.  4.  Food  of  a  simple  character,  sufficient  in  quantity, 
thoroughly  cooked,  shall  be  issued  to  those  detained  in  quaran- 
tine.    No  fruit  shall  be  permitted. 

Par.  5.  Cleanliness  of  quarters  and  of  person  shall  be  enjoined 
and  enforced  daily.  Disinfectants  shall  be  used  where  there  is 
any  possibility  of  infection. 

Par.  6.  Water-closets,  urinals,  privies,  or  troughs  shall  be  pro- 
vided, and  their  contents  disinfected  before  they  are  discharged. 

1  The  quantity  of  water  of  ammonia  required  for  neutralization  after  each  of 
the  above-named  methods  is  as  follows:  After  method  [a),  )/2  liter  (0.52 
quart)  of  water  of  ammonia  for  each  liter  ( 1. 04  quarts)  of  formalin;  after 
method  (b),  ^  liter  of  water  of  ammonia  for  each  150  grams  (5  ounces)  of 
trioxymethylene. 

2  The  special  apparatus  must  consist  of  a  generator,  constructed  of  copper, 
for  evolving  formaldehyd  gas  from  its  solutions,  and  a  similar  one  of  iron  for 
evolving  ammonia  gas  for  neutralization.  The  principle  upon  which  this  ap- 
paratus is  constructed  is  described  and  illustrated  in  Public  Health  Reports, 
Marine-Hospital  Service,  January  29,  1897,  vol.  xii.,  No.  5,  and  September 
22,  1899,  vol.  xiv.,  No.  3%. 


438  QUARANTINE. 

Par.  7.  In  any  group  in  which  cholera  appears,  the  sick  will  be 
immediately  isolated  in  hospital,  and  the  remaining  persons  in  the 
group  shall  be  bathed  and  their  effects  be  disinfected,  then  re- 
moved to  other  quarters,  if  possible,  and  the  compartment  dis- 
infected. 

Par.  8.  No  direct  communication  shall  be  allowed  between  the 
physician  and  attendants  of  the  hospital  and  those  detained  in 
quarantine. 

No  person  shall  be  discharged  from  quarantine  until  five  days 
have  elapsed  since  the  last  exposure  to  infection  and  a  final  disin- 
fection of  such  effects  as  were  taken  to  barracks. 

No  convalescent  from  cholera  shall  be  discharged  from  quaran- 
tine until  after  a  sufficient  time  has  elapsed  to  insure  his  freedom 
from  infection.1 

Par.  9.  The  body  of  no  person  dead  of  cholera  shall  be  allowed 
to  pass  through  quarantine.  The  body  should  be  cremated  if 
practicable.  If  not,  it  should  be  wrapped,  without  preliminary 
washing,  in  a  sheet  saturated  with  a  solution  of  bichlorid  of  mer- 
cury, 1  :  500,  and  buried,  surrounded  by  caustic  lime. 

Article  VII. — Disinfection  of  Personal  Effects  of  Passen- 
gers and  Crew  and  Cargo. 

Par.  1.  Clothing,  bedding,  and  articles  not  injured  by  steam 
shall  be  disinfected — 

(a)  By  exposure  to  steam  at  a  temperature  of  ioo°  to  1020  C. 
for  thirty  minutes  after  such  temperature  has  been  reached. 

{&)  By  boiling  for  fifteen  minutes ;  all  articles  to  be  submerged. 

{/)  By  a  thorough  saturation  in  a  solution  of  bichlorid  of  mer- 
cury, 1  :  1000,  and  allowed  to  dry  before  washing. 

Par.  2.  Articles  injured  by  steam  (rubber,  leather,  etc.),  and 
containers  to  the  disinfection  of  which  steam  is  inapplicable,  shall 
be  disinfected  by  thoroughly  wetting  all  surfaces  with  a  solution 
of  bichlorid  of  mercury,  1  :  800,  or  a  5  per  cent,  solution  of  car- 
bolic acid,  and  allowed  to  dry  in  open  air. 

Par.  3.  Cooking  and  eating  utensils,  by  immersing  in  boiling 
water  or  steam. 

Par.  4.  All  rags  and  old  textile  fabrics  used  in  the  manufacture 
of  paper,  and  all  old  gunny,  old  jute,  etc.,  fit  only  for  remanu- 
facture,  gathered,  collected,  packed,  or  handled  in  any  port  or 
place  where  cholera  (cholerine)  or  yellow  fever  exists,  or  where 
small-pox  or  typhus  fever  prevails  in  epidemic  form,  and  for 
thirty  days  after  the  port  or  place  shall  be  officially  declared  free 
from  such  diseases  or  epidemic,  shall  be  denied  entry  into  any 
port  of  the  United  States. 

Par.  5.  No  rags  or  old  textile  fabrics  used  in  the  manufacture 
of  paper,  or  articles  enumerated  in  the  preceding  paragraph, 
which  have  not  been  disinfected  in  accordance  with  Article  VII., 

1  To  be  determined  by  bacteriologic  examination. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  439 

paragraph  3,  of  the  United  States  Quarantine  Regulations  for 
foreign  ports,  shall  be  admitted  into  the  United  States. 

(Old  jute  bags,  old  cotton  bags,  old  rope,  new  cotton  and  linen 
cuttings  from  factories  not  included.) 

Par.  6.  All  unlabelled  baggage  of  steerage  passengers,  including 
hand  baggage,  and  all  labelled  baggage  of  said  passengers,  which 
in  the  opinion  of  the  quarantine  officer  should  be  disinfected  or 
redisinfected,  arriving  from  oriental  ports,  including  ports  of 
Hawaii,  at  any  port  in  the  States  of  Oregon,  Washington,  or 
California,  shall  be  disinfected  as  provided  in  Article  VII.  of  the 
Quarantine  Regulations  for  domestic  ports  before  being  landed. 

This  regulation  will  also  apply  to  any  other  baggage  which  the 
quarantine  officer  may  suspect  of  being  infected. 

Article  VIII. — Treatment  of  Vessels  Infected  or  Suspected 
of  being  Infected  with  Yellow  Fever. 

Par.  1.  Where  practicable,  at  once  remove  the  sick  to  hos- 
pital ;  remove  and  isolate  all  persons  not  required  for  the  care  of 
the  vessel. 

Par.  2.  If  the  hold  is  deemed  infected,  there  shall  be  a  pre- 
liminary disinfection  as  hereinafter  provided. 

Par.  3.  The  bilge  should  be  cleansed  with  sea  water,  if  pos- 
sible, before  disinfection,  and  the  hold  rendered  mechanically 
clean. 

Par.  4.  All  ballast,  except  close-grained,  hard  rock,  must  be 
discharged.  This  may  be  be  retained  aboard  if  disinfected  by 
immersion  in  an  acid  solution  of  bichlorid  of  mercury,  1  :  800. 

Par.  5.  After  discharge  or  disinfection  of  ballast  the  vessel 
should  be  disinfected. 

Par.  6.  If  it  is  so  stowed  as  to  admit  of  disinfection,  the  cargo 
and  the  hold  may  be  disinfected  without  breaking  bulk,  except  to 
such  a  degree  as  to  render  disinfection  practicable. 

It  shall  be  as  follows  : 

Holds  to  be  treated  with  sulphur  dioxid,  10  per  cent,  strength 
per  volume,  forty-eight  hours'  exposure  for  iron  vessels,  seventy- 
two  hours'  exposure  for  wooden  vessels. 

Par.  7.  Empty  holds  to  be  disinfected  as  follows  : 

(a)  If  of  iron,  by  sulphur  dioxid  gas,  10  per  cent,  strength  per 
volume,  for  twelve  hours'  exposure,  or  by  washing  with  a  solution 
of  bichlorid  of  mercury,  1  :  800,  applied  under  pressure  to  all 
surfaces  by  means  of  a  hose. 

(b)  If  of  wood,  by  both  of  the  preceding  methods,  save  that 
the  exposure  to  sulphur  dioxid  gas  shall  be  for  twenty-four  hours, 
air  streaks  to  be  open ;  the  use  of  gas'  to  precede  the  use  of  the 
mercuric  solution. 

Par.  8.  Cabin,  forecastle,  etc.,  after  mechanical  cleansing,  to 
be  first  treated  with  sulphur  dioxid,  not  less  than  6  per  cent, 
strength  per  volume,  twenty-four  hours'  exposure.      Then  (after 


44-0  QUARANTINE. 

cleansing  with  water,  if  desired)  wash  all  exposed  surfaces  with  a 
solution  of  bichlorid  of  mercury,  i  :  800,  or  pure  carbolic  acid,  3 
per  cent. 

Par.  9.  Clothing,  bedding,  and  all  fabrics  which  can  be 
removed,  not  injured  by  steam,  shall  be  disinfected  : 

(a)  By  exposure  to  steam  at  a  temperature  of  ioo°  to  1020  C.  for 
thirty  minutes  after  such  temperature  has  been  reached. 

(b)  By  boiling  for  fifteen  minutes  ;  all  articles  to  be  submerged. 
{/)  By  a  thorough  saturation  in  a  solution  of  bichlorid  of  mer- 
cury, 1  :  1000,  and  allowed  to  dry  before  washing. 

Par.  10.  Articles  injured  by  steam  (rubber,  leather,  etc.),  and 
containers,  to  the  disinfection  of  which  steam  is  inapplicable, 
shall  be  disinfected  by  (a)  thoroughly  wetting  all  surfaces  with  a 
solution  of  bichlorid  of  mercury,  1  :  800,  or  a  5  per  cent,  solution 
of  pure  carbolic  acid,  and  allowed  to  dry  in  open  air  ;  or  (b~)  by 
exposure  to  the  sulphur  fumigation,  in  cabin,  forecastle,  or  hold, 
or  by  method  prescribed  in  Article  V.,  paragraphs  8  and  9. 

Par.  11.  The  personnel  of  the  vessel  shall  be  detained  five 
days  from  the  completion  of  the  disinfection,  or  three  days  if  all 
baggage,  effects  of  passengers  and  crew,  and  the  vessel  are  handled 
exclusively  by  quarantine  employes. 

Par.  12.  If  the  vessel  has  been  disinfected  under  the  super- 
vision of  an  accredited  medical  officer  of  the  United  States  at  the 
port  of  departure,  the  period  of  quarantine  may  date  from  com- 
pletion of  such  disinfection,  and  shall  not  be  less  than  five  days. 

Article  IX. 

Passenger  traffic  may  be  allowed  during  the  quarantine  season 
from  any  port  infected  with  yellow  fever  to  any  port  of  the  United 
States  south  of  the  southern  boundary  of  Maryland  under  the  fol- 
lowing conditions  : 

(a)  Vessels  to  be  of  iron  and  clean  immediately  prior  to  taking 
on  passengers. 

(b)  The  vessel  must  lie  at  moorings  in  the  open  harbor  and  not 
approach  the  wharves,  nor  must  the  crew  be  allowed  ashore  at  the 
port  of  departure. 

(V)  All  passengers  and  crew  must  be  immune  to  yellow  fever, 
and  so  certified  by  the  United  States  medical  officer.1 

(d)  All  baggage  which  has  not  been  disinfected  at  the  port  of 
departure  by  the  United  States  medical  officer,  or  which  is  not  in 
bond  for  points  north  of  the  southern  boundary  of  Maryland, 
shall  be  disinfected  at  the  quarantine  at  the  port  of  arrival ;  no 
bedding  or  household  effects  to  be  allowed  to  enter. 

1  The  evidence  of  immunity  which  may  be  accepted  by  the  sanitary  inspector 
is  :  First,  proof  of  continued  residence  in  an  endemic  focus  of  yellow  fever  for 
ten  years;  second,  proof  of  previous  attack  of  yellow  fever. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  441 

Article  X. — Miscellaneous. 

Par.  1.  The  treatment  of  vessels  infected  with  typhus  fever 
shall  be  the  same  as  that  prescribed  for  yellow  fever. 

Par.  2.  The  detention  of  passengers  and  crew  for  small-pox 
and  typhus  fever  shall  cover  the  period  of  incubation  of  the  dis- 
ease, the  time  of  detention  to  commence  from  the  date  of  last 
exposure ;  typhus  fever,  not  less  than  twenty  days ;  small-pox,  not 
less  than  fourteen  days. 

Par.  3.  Vessels  detained  at  any  national  quarantine  will  be 
subject  to  such  additional  rules  and  regulations  as  may  be  promul- 
gated from  time  to  time  by  the  Supervising  Surgeon-General. 

Par.  4.  The  following  is  the  form  of  certificate  which  shall  be 
issued  to  the  vessel  by  the  health  officer  when  she  is  released  from 
quarantine  : 

, ,  190- . 

I  certify  that ,  of  ,  from ,  has   in  all  respects   complied 

with  the  quarantine  regulations  prescribed  by  the  Secretary  of  the  Treasury, 
and  that  in  my  opinion  she  will  not  convey  quarantinable  disease.  Said  vessel 
is  this  day  granted  free  pratique. 


Health   Quarantine  Officer, 

Port  of . 

Article  XL — Inspection  of  State  and  Local  Quarantines. 

In  the  performance  of  the  duties  imposed  upon  him  by  the  act 
of  February  15,  1893,  the  Supervising  Surgeon-General  of  the 
Marine-Hospital  Service  shall,  from  time  to  time,  personally  or 
through  a  duly  detailed  officer  of  the  Marine-Hospital  Service, 
inspect  the  maritime  quarantines  of  the  United  States,  State  and 
local  as  well  as  national,  for  the  purpose  of  ascertaining  whether 
the  quarantine  regulations  prescribed  by  the  Secretary  of  the 
Treasury  have  been  or  are  being  complied  with.  The  Supervising 
Surgeon-General,  or  the  officer  detailed  by  him  as  inspector,  shall 
at  his  discretion  visit  any  incoming  vessel,  or  any  vessel  detained 
in  quarantine,  and  all  portions  of  the  quarantine  establishment,  for 
the  above-named  purpose  and  with  a  view  to  certifying,  if  need 
be,  that  the  regulations  have  been  or  are  being  enforced. 

Article  XII. — Canadian  and  Mexican    Frontiers. 

Par.  i.  When  practicable,  alien  immigrants  arriving  at  Cana- 
dian and  Mexican  ports,  destined  for  the  United  States,  shall  be 
inspected  at  the  port  of  arrival  by  the  United  States  consular  or 
medical  officer,  and  be  subjected  to  the  same  sanitary  restrictions 
as  are  called  for  by  the  rules  and  regulations  governing  United 
States  ports. 

Par.  2.  Inspection  cards  will  be  issued  by  the  consular  or  United 
States  medical  officer  at  the  port  of  arrival  to  all  such  alien  immi- 
grants, and  labels  affixed  to  their  baggage,  as  are  required  in  the 


442  QUARANTINE. 

case  of  those  coming  direct  from  foreign  ports  to  any  port  of  the 
United  States. 

Par.  3.  "Whenever  alien  immigrants  are  not  inspected  at  the 
port  of  arrival  by  the  United  States  consular  or  medical  officer, 
they  shall  enter  the  United  States  through  certain  designated  places 
on  the  frontier,  where  they  shall  be  inspected  for  the  purpose  of 
preventing  the  introduction  of  quarantinable  disease.  This  in- 
spection shall  be  held  by  daylight. 

Par.  4.  If  any  person  be  found  suffering  from  a  quarantinable 
disease,  or  presumably  infected,  he  shall  be  denied  entry  so  long 
as  danger  of  conveying  the  infection  exists. 

Par.  5.  Any  baggage  or  other  effects  believed  to  be  infected 
shall  be  refused  entry  until  made  safe  by  a  proper  disinfection. 

Par.  6.  Persons  coming  from  localities  where  small-pox  is  pre- 
vailing in  epidemic  form  shall  not  be  allowed  entry  without  vac- 
cination, unless  they  are  protected  by  a  previous  attack  of  the 
disease  or  a  recent  successful  vaccination. 

Par.  7.  Persons  coming  from  localities  where  typhus  fever  pre- 
vails in  epidemic  form  shall  not  be  allowed  entry  until  they  have  been 
away  from  such  locality  fourteen  days  and  their  baggage  disinfected. 

Par.  8.  During  the  quarantine  season  persons  coming  from 
places  where  yellow  fever  prevails  will  not  be  permitted  to  enter 
until  they  have  been  away  from  such  locality  ten  days  and  their 
baggage  has  been  disinfected.  But  persons  immune  to  yellow 
fever  will  not  be  detained. 

Par.  9.  No  common  carrier  which  is  infected,  or  suspected  of 
being  infected,  shall  be  allowed  to  enter  the  United  States  until 
after  such  measures  have  been  taken  as  will  render  it  safe. 

Par.  10.  Articles  of  merchandise,  personal  effects,  etc.,  which 
are  capable  of  conveying  infection,  and  which  are  presumably  in- 
fected, shall  not  be  allowed  entry  into  the  United  States  until  after 
disinfection. 

Par.  11.  The  methods  of  disinfection  shall  be  those  prescribed 
in  the  rules  and  regulations  made  for  the  maritime  quarantines 
of  the  United  States. 

Immigrants  who,  with  their  baggage,  have  been  inspected  at  a 
port  of  the  United  States  by  a  quarantine  officer  upon  landing, 
will  be  exempt  from  further  quarantine  inspection  when  re-entering 
the  United  States  from  Canada,  unless  there  is  reason  to  believe 
that  disease  has  developed  among  such  immigrants  since  such  land- 
ing and  inspection. 

Par.  12.  Rags  gathered  and  baled  in  Canada,  accompanied  by 
affidavits  that  the  ports  or  places  where  collected  or  handled  were 
free  from  quarantinable  diseases  for  thirty  days  prior  to  shipment, 
may  be  admitted  to  entry  ;  but  rags  from  foreign  ports  shipped 
through  Canada  shall  not  be  admitted  to  entry  unless  they  are 
accompanied  by  a  certificate  of  a  United  States  consul  or  medical 
officer  of  the  United  States  that  they  have  been  disinfected  in 
accordance  with  the  United  States  quarantine  regulations. 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  443 

Foreign  rags,  not  originating  in  Canada,  but  shipped  through 
Canada  to  ports  in  the  United  States,  will  not  be  admitted  to 
entry  by  collectors  of  customs  unless  accompanied  by  the  above- 
named  certificate,  or  until  after  they  have  been  unbaled  and  dis- 
infected as  required  by  the  United  States  quarantine  regulations. 

Article  XIII. — Special  Regulations  Relating  to  Naval 
Vessels. 

Par.  1.  Such  communication  may  be  allowed  with  vessels  of 
the  United  States  Navy  as  the  certificate  of  the  medical  officer 
of  said  vessel  shows  will  not  be  liable  to  convey  infection. 

Par.  2.  The  certificates  of  the  medical  officers  of  the  United 
States  Navy  that  the  United  States  quarantine  regulations  have 
been  complied  with  may  be  accepted  for  naval  vessels. 

Par.  3.  Vessels  of  the  United  States  Navy,  having  entered  the 
harbors  of  ports  infected  with  yellow  fever,  and  having  held  no 
communication  which  is  liable  to  convey  infection  to  the  vessel 
or  her  crew,  may  be  exempted  from  the  quarantine  restrictions 
imposed  on  merchant  vessels  from  such  ports. 

Article  XIV. — Treatment  of  Vessels  Suspected  of  Plague. 

Par.  1.  The  regulations  heretofore  promulgated  with  regard  to 
cholera  shall  be  observed  with  regard  to  vessels,  cargo,  passen- 
gers, and  crews  infected,  or  suspected  of  being  infected,  with 
plague ;  but  persons  who  have  been  exposed  to  the  infection,  or 
are  liable  to  convey  the  disease,  shall  be  detained  for  a  period 
of  not  less  than  fifteen  days  from  the  last  possible  exposure  to  in- 
fection. 

Par.  2.  If  a  vessel  has  been  disinfected  at  the  port  of  depart- 
ure and  the  personnel  bathed  and  their  body-clothing  and  bag- 
gage disinfected  by  a  commissioned  medical  officer  of  the  Marine- 
Hospital  Sendee,  where  proper  facilities  for  such  work  exist,  and 
in  all  other  respects  has  complied  with  the  United  States  Treasury 
regulations,  and  if  no  suspicious  sickness  has  occurred  en  route, 
such  vessels  may,  in  the  discretion  of  the  quarantine  officer,  have 
the  time  of  the  voyage  deducted  from  the  period  of  detention. 

Par.  3.  No  person  from  an  infected  or  suspected  port  or  place 
shall  be  admitted  into  the  United  States  until  a  total  period  of 
fifteen  days  shall  have  elapsed  under  observation  either  at  the 
port  of  departure,  at  sea,  or  at  port  of  arrival,  excepting  as  here- 
inafter provided. 

Par.  4.  A  first-cabin  passenger,  bearing  the  certificate  of  an 
officer  of  the  Marine-Hospital  Service,  certifying  to  non-exposure 
to  the  infection  of  plague  for  the  fifteen  days  immediately  pre- 
ceding embarkation,  may  be  admitted  to  entry  without  detention, 
provided,  in  the  opinion  of  the  quarantine  officer  at  the  port  of 
arrival,  he  has  not  been  exposed  en  route  to  persons  or  things 
presumably  infected. 


444  QUARANTINE. 

Par.  5.  All  passengers,  excepting  the  first-cabin  passengers, 
shall  be  bathed  and  body-clothing  disinfected  before  landing. 
Similar  measures  shall  be  taken  with  the  crew  and  their  effects  if 
the  quarantine  officer  believes  the  crew  has  been  exposed  to  in- 
fection. 

Par.  6.  All  baggage  from  infected  places  should  be  disinfected, 
either  at  the  port  of  departure  or  entrance,  in  full  accordance 
with  United  States  quarantine  regulations.  When  disinfected  at 
the  port  of  departure,  the  containers  shall  be  sealed  and  ticketed 
with  a  yellow  "  disinfected"  label,  signed  by  a  medical  officer  of 
the  Marine-Hospital  Service  at  the  port  of  departure ;  and  if  seals 
and  labels  are  intact  at  port  of  arrival,  such  packages  may,  in  his 
discretion,  be  passed  by  the  quarantine  officer  at  the  port  of  ar- 
rival without  further  disinfection.  Hand  baggage  and  baggage 
opened  or  used  on  the  voyage  must  be  disinfected  on  arrival.  In 
no  case  shall  soiled  body-linen  be  admitted  without  disinfection. 

Par.  7.  A  vessel  from  a  plague-infected  or  suspected  port,  carry- 
ing passengers  but  no  ship's  surgeon,  may,  in  the  discretion  of  the 
•  quarantine  officer,  be  quarantined  with  all  on  board,  for  the  full 
fifteen  days  from  the  completion  of  disinfection. 

Par.  8.  A  vessel  from  a  plague-infected  or  suspected  port,  ar- 
riving with  fewer  persons  on  board  than  are  accounted  for  on  the 
bill  of  health,  may,  in  the  discretion  of  the  quarantine  officer,  be 
considered  as  an  infected  vessel. 

Par.  9.  Vessels  suspected  of  plague  shall  be  disinfected  in 
whole  or  in  part,  in  the  discretion  of  the  quarantine  officer,  and 
said  disinfection  shall  be  in  accordance  with  the  provisions  of 
Article  XVI. 

Article  XV. — Treatment  of  Plague-infected  Vessels. 

Par.  1.  Remove  all  passengers  from  the  vessel,  and  all  of  the 
crew  save  those  necessary  to  care  for  her.  Place  the  sick,  if  any, 
in  hospital,  and  isolate  those  specially  suspected.  Segregate  the 
remainder  in  small  groups  wherever  facilities  for  such  segregation 
exist. 

Par.  2.  Persons  with  abrasions  or  open  sores  should  have  them, 
protected  with  proper  dressings  before  being  permitted  to  handle 
persons  or  articles  believed  to  be  infected  with  plague. 

Par.  3.  Preliminary  Disijifection. — After  removal  of  the  per- 
sonnel a  preliminary  disinfection  of  all  accessible  parts  of  the 
vessel  must  be  performed  with  sulphur  dioxid.  This  preliminary 
disinfection  should  be  started  in  the  morning,  in  order  that  guards 
may  be  placed  on  deck  and  in  small  boats  around  the  vessel  to 
detect  and  destroy  escaping  rats. 

Par.  4.  The  water-supply  must  be  changed  without  delay,  the 
casks  or  tanks  disinfected  by  steam  or  10  per  cent,  solution  of 
potassium  permanganate,  and,  after  thorough  rinsing,  refilled  from 
a  source  of  undoubted  purity  ;  or  the  water-supply  must  have  been 


QUARANTINE  LAWS  OF  THE  UNITED  STATES.  445 

recently  boiled.  Some  water  tanks  are  not  readily  inspected  and 
cleansed  on  account  of  their  inaccessibility  ;  these  may  be  ren- 
dered safe  by  leading  a  steam  pipe  into  them  and  boiling  the  water 
in  situ. 

Par.  5.  Nothing  shall  be  thrown  overboard  from  the  vessel — 
not  even  deck-sweepings.  Such  material  shall  be  burned  in  the 
furnace  or  in  a  place  specially  designated,  but  not  in  the  galley. 

Par.  6.  Plague-infected  vessels  shall  be  disinfected  in  accord- 
ance with  Article  XVI. 

Par.  7.   Detention  of  personnel. 

(a)  If  practicable,  antipeste  serum  should  be  used  as  a  prevent- 
ive measure  on  all  the  personnel  of  any  vessel  arriving  with  a 
history  of  sickness  of  a  suspicious  character  on  board  during  the 
voyage. 

{b)  The  personnel  of  vessel  shall  be  detained  under  observation 
fifteen  days  from  the  last  possible  exposure  to  infection. 

{c)  The  people  detained  shall  be  inspected  by  the  physician 
twice  daily,  and  be  under  his  constant  surveillance,  and  no  inter- 
course will  be  allowed  between  the  different  groups  while  in  quar- 
antine. 

(d)  No  direct  communication  shall  be  allowed  between  any 
person  detained  in  quarantine  and  anyone  not  in  quarantine, 
except  through  the  quarantine  officer. 

{e)  The  water-  and  food-supply  shall  be  strictly  guarded  to  pre- 
vent contamination,  and  issued  to  each  group  separately. 

(/")  Cleanliness  of  quarters  and  of  persons  shall  be  enjoined 
and  enforced  daily.  Disinfection  shall  be  used  where  there  is 
any  possibility  of  infection. 

(g)  Water-closets,  urinals,  privies,  or  troughs  shall  be  provided, 
and  their  contents  disinfected  before  they  are  discharged. 

(h)  In  any  group  in  which  plague  appears  the  sick  shall  be 
immediately  isolated  in  hospital,  and  the  remaining  persons  in 
the  group  shall  be  bathed  and  their  effects  disinfected,  then  re- 
moved to  other  quarters,  if  possible,  and  the  compartment  disin- 
fected. 

(7)  No  convalescent  from  plague  shall  be  discharged  from  quar- 
antine until  after  a  sufficient  time  has  elapsed  to  insure  his  freedom 
from  infection,  to  be  determined  by  bacteriologic  examination. 

(/£)  The  body  of  no  person  dead  of  plague  shall  be  allowed  to 
pass  through  quarantine.  The  body  should  be  cremated,  if  prac- 
ticable. If  not,  it  should  be  wrapped,  without  preliminary  wash- 
ing, in  a  sheet  saturated  with  a  solution  of  bichlorid  of  mercury, 
1  :  500,  surrounded  in  the  coffin  by  twice  the  body- weight  of 
caustic  lime,  and  buried. 

(/)  Mammalian  animals,  such  as  dogs,  cats,  monkeys,  mice,  etc., 
which  not  infrequently  accompany  passengers  as  pets,  should 
not  be  shipped  from  a  plague-infected  or  suspected  port  or  place. 
Should,  however,  such  arrive,  they  shall  be  held  in  quarantine  at 
least  fifteen  days. 


446  QUARANTINE. 

Article  XVI. — Disinfection  of  Vessels  Infected  or  Suspected 
of  being  Infected  with  Plague. 

Par.  i.  Holds  of  iron  vessels. 

(a)  With  Cargo. — By  twenty-four  hours'  exposure  to  sulphur 
dioxid,  10  per  cent,  per  volume  strength,  generated  by  an  ap- 
proved furnace,  or  forty-eight  hours'  exposure  to  5  per  cent,  per 
volume  strength,  generated  by  pots. 

{f)  Where  cases  of  plague,  or  deaths  from  the  same,  have 
occurred  on  board,  or  where  there  have  been  deaths  presumably 
from  plague  among  the  rats  on  a  vessel,  the  cargo  shall  be  light- 
ered, in  order  to  complete  the  disinfection  of  the  vessel  and 
facilitate  the  removal  of  all  rats  and  other  vermin. 

This  same  procedure  may  be  required  by  the  quarantine  officer 
whenever  in  his  judgment  the  vessel  or  cargo  is  disinfected. 

(<r)  Where  it  can  be  procured  in  sufficient  quantity,  liquefied 
sulphur  dioxid  may  be  used  in  the  disinfection  of  cargoes,  holds, 
and  living  apartments,  it  being  borne  in  mind  that  it  will  be 
necessary  to  employ  2  pounds  of  this  material  in  lieu  of  1  pound 
of  sulphur  where  indicated  in  the  above  regulations. 

(d )  No  person  should  be  allowed  on  the  vessel  or  around  the 
cargo  with  bare  feet,  and  the  use  of  proper  precaution  in  handling 
dead  vermin  is  advised. 

(<?)  Without  Cargo. — After  the  preliminary  disinfection  pro- 
vided for  in  Article  XV.,  paragraph  3,  followed  by  mechanical 
cleansing,  the  hold  must  be  thoroughly  washed  with  a  solution 
of  bichlorid  of  mercury,  1  :  800,  applied  under  pressure  to  all 
surfaces  by  means  of  a  hose  ;  or  disinfected  by  sulphur  dioxid,  10 
per  cent,  per  volume  strength,  for  twenty-four  hours,  or  5  per  cent, 
per  volume  strength  for  forty-eight  hours. 

{/)  The  water  ballast  of  a  vessel  coming  from  infected  or 
suspected  ports  should  be  discharged  at  sea,  or,  if  discharged  in 
fresh  or  brackish  water,  must  be  previously  disinfected,  the  tanks 
to  be  flushed  and  refilled  with  sea-water  or  disinfected. 

Par.  2.   Holds  of  woode?i  vessels. 

For  a  wooden  vessel  the  treatment  is  the  same  as  for  iron  ves- 
sels, except  that  the  exposure  of  the  hold  to  sulphur  dioxid,  10 
per  cent,  per  volume  strength,  must  precede  the  washing  with 
bichlorid,  and  this  exposure  must  be  forty-eight  hours  in  wooden 
vessels  without  cargo  ;  or  if  only  5  per  cent,  per  volume  strength 
sulphur  dioxid  is  obtainable,  the  exposure  must  be  seventy-two 
hours. 

Par.  3.  All  solid  ballast  on  vessels  infected,  or  suspected  of 
being  infected,  with  plague,  to  be  discharged  or  disinfected  pre- 
vious to  disinfection  of  hold ;  all  such  ballast  discharged  in  fresh 
water  to  be  disinfected  by  saturation  with,  or  immersion  in,  a 
solution  of  bichlorid  of  mercury,  1  :  800. 

Par.  4.  Clear,  hard,  close-grained  rock  may  be  permitted  to 
remain  on  board,  but  only  after  disinfection  by  immersion  in  a 


INTERSTATE  QUARANTINE.  447 

solution  of  1  :  800  of  bichlorid  of  mercury.  Ballast  removed  from 
vessels  infected,  or  suspected  of  being  infected,  with  plague,  must 
not  be  taken  from  the  quarantine  station. 

Par.  5.  Bilges  shall  be  cleansed  and  disinfected  in  the  manner 
provided  for  water-tanks  (Article  XV.,  paragraph  4). 

Par.  6.   Living  compartments  of  all  classes  of  vessels. 

(a)  The  preliminary  disinfection  shall  be  done  with  sulphur 
dioxid  and  not  with  formaldehyd,  on  account  of  the  greater  potency 
of  the  former  against  animal  life. 

(//)  After  this  preliminary  disinfection  remove  bedding,  hang- 
ings, carpets,  clothing,  and  textiles,  for  disinfection  by  steam  or 
boiling,  or  other  methods  prescribed  by  United  States  quarantine 
regulations.  Subsequently  the  compartments  themselves,  with  the 
non-removable  fabrics  therein,  shall  be  disinfected  in  accordance 
with  the  United  States  quarantine  regulations. 

Par.  7.  Personal  Effects. — Clothing,  bedding,  and  other  such 
articles  shall  be  disinfected  in  accordance  with  the  provisions  of 
Articles  V.  and  VIII.,  United  States  quarantine  regulations. 

Par.  8.  After  the  cargo  has  been  discharged,  the  vessel  must 
be  submitted  to  a  disinfection  of  all  parts  simultaneously  by  sul- 
phur dioxid  gas  of  5  per  cent,  per  volume  strength  for  not  less 
than  twenty-four  hours,  in  order  to  insure  destruction  of  all  animal 
life  aboard.  The  remains  of  all  rats  and  vermin  should  be  gath- 
ered and  burned,  and  the  places  where  gathered  subsequently  dis- 
infected.    Rats  must  not  be  handled  with  bare  hands. 

Par.  9.  After  final  disinfection  as  provided  in  paragraph  8,  the 
vessel  must  be  kept  under  observation  a  sufficient  length  of  time  to 
satisfy  the  quarantine  officer  that  the  ship  is  freed  from  all  rats  and 
vermin. 

INTERSTATE   QUARANTINE. 

All  interstate  quarantine  powers  of  trie  United  States 
have  also  been  conferred  upon  the  Supervising'  Surgeon- 
General  of  the  Marine-Hospital  Service.  The  following 
is  a  transcript  of  the  act  of  Congress  conferring  these 
powers  and  the  interstate  quarantine  regulations: 

[Act  of  March  27,  1890.] 

An  Act  to  prevent  the  introduction  of  contagious  diseases  from 
one  State  to  another,  and  for  the  punishment  of  certain  offences. 

Be  it  enacted  by  the  Senate  and  House  of  Representatives  of  the 
United  States  of  America  in  Congress  assembled,  That  whenever 
it  shall  be  made  to  appear  to  the  satisfaction  of  the  President  that 
cholera,  yellow  fever,  small-pox,  or  plague  exists  in  any  State  or 
territory,  or  in  the  District  of  Columbia,  and  that  there  is  danger 
of  the  spread  of  such  disease  into  other  States,  territories,  or  the 
District  of  Columbia,  he  is  hereby  authorized  to  cause  the  Secre- 


448  QUARANTINE. 

tary  of  the  Treasury  to  promulgate  such  rules  and  regulations  as 
in  his  judgment  may  be  necessary  to  prevent  the  spread  of  such 
disease  from  one  State  or  territory  into  another,  or  from  any  State 
or  territory  into  the  District  of  Columbia,  or  from  the  District  of 
Columbia  into  any  State  or  territory,  and  to  employ  such  regula- 
tions to  prevent  the  spread  of  such  disease.  The  said  rules  and 
regulations  shall  be  prepared  by  the  Supervising  Surgeon-General 
of  the  Marine-Hospital  Service,  under  the  direction  of  the  Secre- 
tary of  the  Treasury.  And  any  person  who  shall  wilfully  violate 
any  rule  or  regulation  so  made  and  promulgated  shall  be  deemed 
guilty  of  a  misdemeanor,  and  upon  conviction  shall  be  punished 
by  a  fine  of  not  more  than  five  hundred  dollars,  or  imprisonment 
for  not  more  than  two  years,  or  both,  in  the  discretion  of  the 
court. 

Sec.  2.  That  any  officer,  or  person  acting  as  an  officer,  or  agent 
of  the  United  States  at  any  quarantine  station,  or  other  person 
employed  to  aid  in  preventing  the  spread  of  such  disease,  who 
shall  wilfully  violate  any  of  the  quarantine  laws  of  the  United 
States,  or  any  of  the  rules  and  regulations  made  and  promulgated 
by  the  Secretary  of  the  Treasury,  as  provided  for  in  Section  i  of 
this  act,  or  any  lawful  order  of  his  superior  officer  or  officers, 
shall  be  deemed  guilty  of  a  misdemeanor,  and  upon  conviction 
shall  be  punished  by  a  fine  of  not  more  than  three  hundred  dollars, 
or  imprisonment  for  not  more  than  one  year,  or  both,  in  the  dis- 
cretion of  the  court. 

Sec.  3.  That  when  a  common  carrier,  or  officer,  agent,  or 
employe  of  any  common  carrier,  shall  wilfully  violate  any  of  the 
quarantine  laws  of  the  United  States,  or  the  rules  and  regulations 
made  and  promulgated  as  provided  for  in  Section  1  of  this  act, 
such  common  carrier,  officer,  agent,  or  employe  shall  be  deemed 
guilty  of  a  misdemeanor,  and  shall,  on  conviction,  be  punished 
by  a  fine  of  not  more  than  five  hundred  dollars,  or  imprisonment 
for  not  more  than  two  years,  or  both,  in  the  discretion  of  the 
court. 


INTERSTATE  QUARANTINE  REGULATIONS. 

Article  I. 

QUARANTINABLE    DISEASES. 

(1)  For  the  purposes  of  these  regulations  the  quarantinable  dis- 
eases are  cholera  f  cholerine),  yellow  fever,  small-pox,  typhus  fever, 
leprosy,  and  plague. 

Article  II. 

NOTIFICATION. 

fi)  State  and  municipal  health  officers  should  immediately 
notify  the  Supervising  Surgeon-General  of  the  U.  S.  Marine-Hos- 


INTERSTATE  QUARANTINE  REGULATIONS.  449 

pital  Service  by  telegraph  or  by  letter  of  the  existence  of  any  of 
the  above-mentioned  quarantinable  diseases  in  their  respective 
States  or  localities. 

Article  III. 

GENERAL    REGULATIONS. 

(1)  Persons  suffering  from  a  quarantinable  disease  shall  be 
isolated  until  no  longer  capable  of  transmitting  the  disease  to 
others.  Persons  exposed  to  the  infection  of  a  quarantinable  dis- 
ease shall  be  isolated,  under  observation,  for  such  a  period  of  time 
as  may  be  necessary  to  demonstrate  their  freedom  from  the  disease. 

All  articles  pertaining  to  such  persons,  liable  to  convey  infec- 
tion, shall  be  disinfected  as  hereinafter  provided. 

(2)  The  apartments  occupied  by  persons  suffering  from. quaran- 
tinable disease,  and  adjoining  apartments  when  deemed  infected, 
together  with  articles  therein,  shall  be  disinfected  upon  the  ter- 
mination of  the  disease. 

(3)  Communication  shall  not  be  held  with  the  above-named 
persons  and  apartments,  except  under  the  direction  of  a  duly 
qualified  officer. 

(4)  All  cases  of  quarantinable  disease,  and  all  cases  suspected 
of  belonging  to  this  class,  shall  be  at  once  reported  by  the  physi- 
cian in  attendance  to  the  proper  authorities. 

(5)  No  common  carrier  shall  accept  for  transportation  any  per- 
son suffering  with  a  quarantinable  disease,  nor  any  infected  article 
of  clothing,  bedding,  or  personal  property. 

The  body  of  any  person  who  has  died  of  a  quarantinable  dis- 
ease shall  not  be  transported  save  in  hermetically  sealed  coffins, 
and  by  the  order  of  the  State  or  local  health  officer. 

(6)  In  the  event  of  the  prevalence  of  small-pox,  all  persons 
exposed  to  the  infection,  who  are  not  protected  by  vaccination  or 
a  previous  attack  of  the  disease,  shall  be  at  once  vaccinated  or 
isolated  for  a  period  of  fourteen  days. 

(7)  During  the  prevalence  of  cholera  all  the  dejecta  of  cholera 
patients  shall  be  at  once  disinfected  as  hereinafter  provided,  to 
prevent  possible  contamination  of  the  food-  and  water-supply. 

Article  IV. 

YELLOW    FEVER. 

In  addition  to  the  foregoing  regulations  contained  in  Article 
III.  the  following  special  provisions  are  made  with  regard  to  the 
prevention  of  the  introduction  and  spread  of  yellow  fever  : 

(1)  Localities  infected  with  yellow  fever,  and  localities  contig- 
uous thereto,  should  be  depopulated  as  rapidly  and  as  completely 
as  possible,  so  far  as  the  same  can  be  safely  done ;  persons  from 
non-infected  localities  and  who  have  not  been  exposed  to  infec- 
tion being  allowed  to  leave  without  detention.  Those  who  have 
been  exposed,  or  who  come  from  infected  localities,  shall  be  re- 

29 


450  QUARANTINE. 

quired  to  undergo  a  period  of  detention  and  observation  of  ten 
days  from  the  date  of  last  exposure  in  a  camp  of  probation  or 
other  designated  place. 

Clothing  and  other  articles  capable  of  conveying  infection  shall 
not  be  transported  to  non-infected  localities  without  disinfection. 

(2)  Persons  who  have  been  exposed  may  be  permitted  to  pro- 
ceed without  detention  to  localities  incapable  of  becoming  in- 
fected and  whose  authorities  are  willing  to  receive  them  and  after 
arrangements  have  been  perfected,  to  the  satisfaction  of  the  proper 
health  officer,  for  their  detention  in  said  localities  for  a  period  of 
ten  days. 

(3)  The  suspects  who  are  isolated  under  the  provisions  of  para- 
graph 1,  Article  III.,  shall  be  kept  free  from  all  possibility  of 
infection. 

(4)  So  far  as  possible,  the  sick  should  be  removed  to  a  central 
location  for  treatment. 

(5)  Buildings  in  which  yellow  fever  has  occurred,  and  localities 
believed  to  be  infected  with  said  disease,  must  be  disinfected  as 
thoroughly  as  possible. 

(6)  As  soon  as  the  disease  becomes  epidemic  the  railroad  trains 
carrying  persons  allowed  to  depart  from  a  city  or  place  infected 
with  yellow  fever  shall  be  under  medical  supervision. 

(7)  Common  carriers  from  the  infected  districts,  or  believed  to 
be  carrying  persons  and  effects  capable  of  conveying  infection, 
shall  be  subject  to  a  sanitary  inspection,  and  such  persons  and 
effects  shall  not  be  allowed  to  proceed,  except  as  provided  for 
by  paragraph  2. 

(8)  At  the  close  of  an  epidemic  the  houses  where  sickness  has 
occurred,  and  the  contents  of  the  same,  and  houses  and  contents 
that  are  presumably  infected,  shall  be  disinfected  as  hereinafter 
prescribed. 

Article  V. 

DISINFECTION. 
FOR    CHOLERA. 

(1)  The  dejecta  and  vomited  matters  of  cholera  patients  shall 
be  received  into  vessels  containing  an  acid  solution  of  bichlorid  of 
mercury  (bichlorid  of  mercury,  1  part ;  hydrochloric  acid,  2 
parts;  water,  1000  parts)  or  other   efficient  germicidal  agent. 

(2)  All  bedding,  clothing,  and  wearing  apparel  soiled  by  the 
discharges  of  cholera  patients  shall  be  disinfected  by  one  or  more 
of  the  following  methods  : 

(a)  By  complete  immersion  for  thirty  minutes  in  one  of  the 
above-named  disinfecting  solutions. 

(b )  By  boiling  for  fifteen  minutes  ;  all  articles  to  be  completely 
submerged. 

(c)  By  exposure  to  steam  at  a  temperature  of  ioo°  to  1020  C. 
for  thirty  minutes  after  such  temperature  is  reached. 


INTERSTATE  QUARANTINE  REGULATIONS.  451 

(3)  Any  woodwork  or  furniture  contaminated  by  cholera  dis- 
charges shall  be  disinfected  by  thorough  washing  with  a  germi- 
cidal solution,  as  provided  in  paragraph  1,  Article  III. 


FOR    YELLOW    FEVER. 

(4)  Apartments  infected  by  occupancy  of  patients  sick  with 
yellow  fever  shall  be  disinfected  by  one  or  more  of  the  following 
methods : 

(a)  By  thorough  washing  with  one  of  the  above-named  germi- 
cidal solutions.  If  apprehension  is  felt  as  to  the  poisonous  effects 
of  the  mercury,  the  surfaces  may,  after  two  hours,  be  washed  with 
clear  water. 

(b)  Thorough  washing  with  a  5  per  cent,  solution  of  pure  car- 
bolic acid. 

(r)  By  sulphur  dioxid,  twenty-four  to  forty-eight  hours'  ex- 
posure, the  apartments  to  be  rendered  as  air-tight  as  possible. 

(5)  Bedding,  wearing  apparel,  carpets,  hangings,  and  draperies 
infected  by  yellow  fever  shall  be  disinfected  by  one  of  the  follow- 
ing methods : 

(a)  By  exposure  to  steam  at  a  temperature  of  ioo°  to  1020  C. 
for  thirty  minutes  after  such  temperature  is  reached. 

(F)  By  boiling  for  fifteen  minutes ;  all  articles  to  be  completely 
submerged. 

(V)  By  thorough  saturation  in  a  solution  of  bichlorid  of  mer- 
cury 1  :  1000,  the  articles  being  allowed  to  dry  before  washing. 

Articles  injured  by  steam  (rubber,  leather,  containers,  etc.),  to 
the  disinfection  of  which  steam  is  inapplicable,  shall  be  disinfected 
by  thoroughly  wetting  all  surfaces  with  (a)  a  solution  of  bichlorid 
of  mercury  1  :  800,  or  (b)  a  5  per  cent,  solution  of  carbolic  acid, 
the  articles  being  allowed  to  dry  in  the  open  air  prior  to  being 
washed  with  water,  or  (V)  by  exposure  to  sulphur  fumigation  in  an 
apartment  air-tight,  or  as  nearly  so  as  possible. 

FOR    SMALL-POX. 

(6)  Apartments  infected  by  small-pox  shall  be  disinfected  by 
one  or  both  of  the  following  methods  : 

(a)  Exposure  to  sulphur  dioxid  for  twenty-four  to  forty-eight 
hours. 

(fr)  Washing  with  a  solution  of  bichlorid  of  mercury,  1  :  1000, 
or  a  5  per  cent,  solution  of  pure  carbolic  acid. 

(7)  Clothing,  bedding,  and  articles  of  furniture  exposed  to  the 
infection  of  small-pox  shall  be  disinfected  by  one  or  more  of  the 
following  methods : 

(a)  Exposure  to  sulphur  dioxid  for  twenty-four  to  forty-eight 
hours. 

(6)  Immersion  in  a  solution  of  bichlorid  of  mercury,  1  :  1000, 
or  5  per  cent,  solution  of  pure  carbolic  acid. 


452  QUARANTINE. 

(V)  Exposure  to  steam  at  a  temperature  of  ioo°  to  1020  C.  for 
thirty  minutes  after  such  temperature  is  reached. 

(d)  Boiling  for  fifteen  minutes ;  the  articles  to  be  completely 
submerged. 

FOR   TYPHUS    FEVER. 

(8)  Apartments  infected  by  typhus  fever  shall  be  disinfected  by 
one  or  both  of  the  following  methods  : 

(a)  Exposure  to  sulphur  dioxid  for  twenty-four  to  forty-eight 
hours. 

(<£)  Washing  with  a  solution  of  bichlorid  of  mercury,  1  :  1000, 
or  a  5  per  cent,  solution  of  pure  carbolic  acid. 

(9)  Clothing,  bedding,  and  articles  of  furniture  exposed  to  the 
infection  of  typhus  fever  shall  be  disinfected  by  one  or  more  of 
the  following  methods : 

(a)  Exposure  to  sulphurdioxid  for  twenty-four  to  forty-eight  hours. 

(i>)  Immersion  in  a  solution  of  bichlorid  of  mercury,  1  :  1000, 
or  a  5  per  cent,  solution  of  pure  carbolic  acid. 

(<:)  Exposure  to  steam  at  a  temperature  of  ioo°  to  1020  C.  for 
thirty  minutes  after  such  temperature  is  reached. 

(d)  Boiling  for  fifteen  minutes;  the  articles  to  be  completely 
submerged. 

INTERSTATE  QUARANTINE  REGULATIONS  TO  PRE- 
VENT THE  SPREAD  OF  PLAGUE  IN  THE  UNITED 
STATES. 

In  accordance  with  the  provisions  of  the  act  of  March  27,  1890, 
the  following  regulations,  additional  to  existing  interstate  quaran- 
tine regulations,  are  hereby  promulgated  to  prevent  the  intro- 
duction of  plague  into  any  one  State  or  territory  or  the  District 
of  Columbia,  from  another  State  or  territory  or  the  District  of 
Columbia : 

1.  During  the  existence  of  plague  at  any  point  in  the  United 
States  the  Surgeon-General  of  the  Marine-Hospital  Service  is 
authorized  to  forbid  •  the  sale  or  donation  of  transportation  by 
common  carrier  to  Asiatics  or  other  races  particularly  liable  to  the 
disease. 

2.  No  common  carrier  shall  accept  for  transportation  any  per- 
son suffering  with  plague  or  any  article  infected  therewith,  nor 
shall  common  carriers  accept  for  transportation  any  class  of  per- 
sons who  may  be  designated  by  the  Surgeon-General  of  the  Marine- 
Hospital  Service  as  being  likely  to  convey  the  risk  of  plague  con- 
tagion to  other  communities,  and  said  common  carriers  shall  be 
subject  to  inspection. 

3.  The  body  of  any  person  who  has  died  of  plague  shall  not 
be  transported  except  in  an  hermetically  sealed  coffin  and  by 
consent  of  the  local  health  office,  in  addition  to  the  local  repre- 
sentatives of  the  Marine-Hospital  Service.  Wherever  possible, 
such  bodies  should  be  cremated. 


STATE  QUARANTINE  REGULATIONS.         453 

STATE  QUARANTINE  REGULATIONS. 

Many  of  the  seaboard  States  of  the  Union  have  quar- 
antine boards  and  stations  in  addition  to  those  of  the 
national  government.  In  1893  the  legislature  of  Penn- 
sylvania passed  a  law  establishing  the  State  Quarantine 
Board  for  the  Port  of  Philadelphia. 

As  early  as  1708,  "An  act  to  prevent  sickly  vessels 
coming  into  this  government ' '  was  passed  by  the  co- 
lonial assembly,  prohibiting  every  unhealthy  or  sickly 
ship  from  an  unhealthy  or  sickly  place  from  coming 
nearer  than  one  mile  to  any  of  the  towns  or  ports  of  the 
province  or  territories  without  clean  bills  of  health.  This 
act  remained  in  force  until  January  22,  1744.  About  the 
year  1742  a  quarantine  station  was  located  at  Fisher's 
Island,  subsequently  called  Province,  and  State  Island. 
In  1749  the  trustees  of  Province  Island  were  directed  to 
build  an  hospital  or  pest-house  for  the  reception  of 
strangers  imported  into  the  province.  During  the  period 
of  the  revolutionary  war  commerce  had  so  dwindled  that 
there  was  very  little  necessity  for  a  quarantine  station. 
The  hospital,  however,  was  used  for  the  care  of  sick 
persons  sent  from  army  boats. 

The  invasion  of  yellow  fever  was  instrumental  in 
causing  an  order  to  be  given  for  the  repairment  of  the 
hospital  upon  State  Island  for  the  admission  of  patients 
and  the  appointment  of  a  resident  physician.  A  resident 
physician  was  appointed  at  the  hospital,  and  vessels 
coming  up  the  river  were  ordered  to  anchor  for  a  visit. 

In  1799  the  quarantine  station  was  located  at  Tinicum 
Island,  and  the  removal  took  place  in  1801,  at  which 
place  it  was  maintained  until  1895,  when  it  was  removed 
to  Marcus  Hook,  its  present  location.  The  service  at 
State  station,  because  of  the  two  national  quarantine 
stations  (Cape  Henlopen  and  Reedy  Island),  is,  for  the 
present,  one  of  observation  or  inspection  only,  there 
being  no  provision  for  detention  or  disinfection.  If 
sickness  of  a  communicable  nature  is  discovered  on  a 


454  QUARANTINE. 

vessel,  or  if  circumstances  lead  to  the  suspicion  that  the 
vessel  herself  is  infected,  she  is  simply  remanded  to  the 
Federal  quarantine  station. 

The  right  to  quarantine  resides  with  the  individual 
States,  though  the  Federal  government  has  the  right  to 
control  in  such  matters  through  its  right  to  regulate 
interstate  commerce.  It  should  have  control  of  the 
matter  of  inland  quarantine  to  the  extent  of  directing 
and  superintending  the  measures  adopted,  in  order  to 
prevent  the  confusion  arising  from  conflicting  regula- 
tions of  the  authorities  of  adjacent  localities.  In  order 
to  secure  more  uniformity  in  the  measures  adopted, 
Congress  has  been  petitioned  time  and  again  to  pass  a 
law  providing  for  the  organization  of  a  National  Board 
of  Health. 

Regulations  of  the  Pennsylvania  State  Board  of 
Health. — The  State  Board  of  Health  has,  from  time  to 
time,  passed  regulations  which  apply  to  conditions  detri- 
mental to  the  public  health  as  they  were  found  to  exist 
throughout  the  State. 

REGULATION  IN  REGARD    TO   THE  ABATEMENT   AND 
REMOVAL  OF  NUISANCES. 

Whenever  a  complaint  is  made  in  writing  to  the  secretary  of  the 
board  of  the  existence  of  a  nuisance,  he  shall  forthwith,  as  exec- 
utive officer  of  the  board,  investigate  the  matter,  and  shall  deter- 
mine whether  the  alleged  nuisance  is  detrimental  to  the  public 
health,  or  the  cause  of  any  special  disease  or  mortality;  and  in 
case  he  shall  so  find,  then  he  shall  notify  the  owner,  agent,  or 
occupier  of  said  premises,  in  writing,  of  such  finding,  and  the 
executive  officer  shall  thereupon   order  and   direct  the  abatement 

and  removal  of  the  same  within days ;  and  in  the  event 

of  the  failure  of  said  owner,  agent,  or  occupier  of  said  property 
to  abate  and  remove  the  nuisance,  then  the  executive  officer  may 
proceed  to  abate  and  remove  the  same,  and  may  employ  all  the 
force  necessary  to  do  so,  and  shall  proceed  by  warrant,  arrest,  and 
indictment  to  convict  the  party  failing  to  obey  said  order  of  abate- 
ment and  removal. 


PENNSYLVANIA  QUARANTINE  REGULATIONS.  455 

PROVISIONAL  REGULATIONS  FOR  PREVENTING  HOUSE-YARDS, 
STREETS,  SLAUGHTER-HOUSES,  STOCK-YARDS,  HOG- 
PENS, BONE-BOILING  AND  FAT-RENDERING  AND  OTHER 
SIMILAR  ESTABLISHMENTS,  FROM  BEING  OR  BECOMING 
PREJUDICIAL   TO  THE  PUBLIC   HEALTH. 

Nuisances  Defined. 

1 .  Whatever  is  dangerous  to  human  life  or  health,  and  whatever 
renders  soil,  air,  water,  or  food  impure  or  unwholesome,  are 
declared  to  be  a  nuisance  and  to  be  illegal,  and  every  person  hav- 
ing aided  in  creating  or  contributing  to  the  same,  or  who  may 
support,  continue,  or  retain  any  of  them,  shall  be  deemed  guilty 
of  a  violation  of  these  regulations. 

House-refuse,  Garbage,  etc. 

2.  No  house-refuse,  offal,  garbage,  dead  animals,  decaying  vege- 
table matter,  or  organic  waste  substances  of  any  kind  shall  be 
thrown  upon  any  street,  road,  ditch,  gutter,  or  public  place,  and 
no  putrid  or  decaying  animal  or  vegetable  matter  shall  be  kept  in 
any  yard,  house,  cellar,  or  adjoining  outbuildings  for  more  than 
twenty-four  hours. 

Noxious  Trades. 

3.  No  person  or  company  shall  erect  or  maintain  any  manufac- 
tory or  place  of  business  dangerous  to  life  or  detrimental  to  health, 
or  where  unwholesome,  offensive,  or  deleterious  odors,  gas,  smoke, 
deposit,  or  exhalations  are  generated,  within  one  mile  of  the  limits 
of  any  city  or  borough,  without  the  permit  of  the  board  of  health 
of  said  city  or  borough ;  and  all  such  establishments  shall  be  kept 
clean  and  wholesome  so  as  not  to  be  offensive  or  prejudicial  to 
public  health ;  nor  shall  any  offensive  or  deleterious  waste  sub- 
stance, refuse,  or  injurious  matter  be  allowed  to  accumulate  upon 
the  premises  or  be  thrown  or  be  allowed  to  run  into  any  public 
waters,  stream,  watercourse,  street,  road,  or  public  place.  And 
every  person  or  company  conducting  such  manufactory  or  business 
shall  use  the  best  approved  and  all  reasonable  means  to  prevent 
the  escape  of  smoke,  gases,  and  odors,  and  to  protect  the  health 
and  safety  of  all  operatives  employed  therein. 

4.  The  business  of  bone-  and  horse-boiling  shall  not  be  allowed, 
unless  conducted  under  cover,  the  building  to  be  provided  with 
smoke-consumers,  and  a  due  regard  to  be  had  to  cleanliness  in  the 
disposition  of  the  offal.  No  bone-boiling  establishment  or  deposi- 
tory of  dead  animals  shall  be  kept  or  erected  in  any  part  of  this 
Commonwealth  which  is  not  under  the  jurisdiction  of  the  local 
board  of  health,  without  a  permit  from  the  board  of  health  of  the 
nearest  city  or  borough. 

5.  No  permit  shall  be  granted  to  any  person  or  persons  to  carry 
on  the  business  of  boiling  bones  of  dead  animals  until  after  a 


456  Q  UARANTINE. 

careful  inspection  of  the  locality,  buildings,  and  apparatus,  and  of 
the  plans  for  conducting  the  business,  by  an  accredited  inspector 
of  the  State  Board  of  Health,  or,  if  such  inspector  be  not  accessi- 
ble, then  by  an  inspector  appointed  for  the  purpose  by  the  board 
of  health  of  the  nearest  city  or  borough. 

6.  No  bone-boiling  establishments  or  depositories  of  dead  ani- 
mals shall  be  kept  or  erected  in  or  near  a  thickly  inhabited  neigh- 
borhood. 

7.  The  floors  of  all  bone-boiling  establishments  and  depositories 
of  dead  animals  shall  be  paved  with  asphalt  or  with  brick  or  stone, 
well  laid  in  cement,  or  with  some  other  impervious  material,  and 
shall  be  well  drained.  All  such  establishments  shall  have  such  an 
adequate  water-supply  as  will  enable  thorough  cleanliness  to  be 
maintained. 

8.  The  boiling  of  bones  and  dead  animals,  etc.,  shall  be  con- 
ducted in  steam-tight  kettles,  boilers,  or  cauldrons,  from  which  the 
foul  vapors  shall  first  be  conducted  through  scrubbers  or  con- 
densers, and  then  into  the  back  part  of  the  ashpit  of  the  furnace 
fire,  to  be  consumed,  or  by  other  apparatus  equally  efficient  in 
preventing  or  counteracting  the  offensive  effluvia. 

9.  When  bones  are  being  dried  after  boiling,  they  shall  be 
placed  in  a  closed  chamber,  through  which  shall  be  passed,  by 
means  of  pipes,  large  volumes  of  fresh  air,  the  outlet  pipe  termin- 
ating in  the  fire-pit. 

10.  All  proprietors  of  bone-boiling  establishments  not  having, 
on  the  first  day  of  July,  1886,  permits  to  carry  on  the  business, 
and  violating  these  regulations,  shall  be  liable  to  prosecution  for 
failing  to  obey  this  order,  and  also  to  an  indictment  at  common 
law  for  creating  and  maintaining  a  nuisance. 

1 1 .  The  permit  clerk  of  each  local  board  of  health  shall  have 
provided  a  book  in  which  to  enter  the  names  of  all  persons  en- 
gaged in  the  business  of  boiling  bones  and  having  depositories  of 
dead  animals ;  also,  the  location  of  works  and  appliances  as 
reported  by  the  inspector,  whether  licensed  or  not,  the  number 
and  date  of  permit,  and  remarks. 

12.  No  person  or  persons,  without  the  consent  of  the  board  of 
health  of  the  nearest  city  or  borough,  shall  build  or  use  any 
slaughter-house  within  the  limits  of  this  Commonwealth  ; .  and  the 
keeping  and  slaughtering  of  all  cattle,  sheep,  and  swine,  and  the 
preparation  and  keeping  of  all  meats,  fish,  birds,  or  otner  animal 
food,  shall  be  in  the  manner  best  adapted  to  secure  and  continue 
their  wholesomeness  as  food ;  and  every  butcher  or  other  person 
owning,  leasing,  or  occupying  any  place,  room,  or  building, 
wherein  any  cattle,  sheep,  or  swine  have  been  or  are  killed  or 
dressed,  and  every  person  being  the  owner,  lessee,  or  occupant  of 
any  room  or  stable  wherein  any  animals  are  kept,  or  of  any 
market,  public  or  private,  shall  cause  such  place,  room  or  building, 
stable  or  market,  to  be  thoroughly  cleansed  and  purified,  and  all 
offal,  blood,  fat,  garbage,  refuse,  and  unwholesome  and  offensive 


PENNSYLVANIA  QUARANTINE  REGULATIONS.  457 

matter  to  be  removed  therefrom  at  least  once  in  every  twenty-four 
hours  after  the  use  thereof  for  any  of  the  purposes  herein  referred 
to,  and  shall  also  at  all  times  keep  all  woodwork,  save  floors  and 
counters,  in  any  building,  place,  or  premises  aforesaid,  thoroughly 
painted  or  whitewashed ;  and  the  floors  of  such  building,  place,  or 
premises  shall  be  so  constructed  as  to  prevent  blood  or  foul  liquids 
or  washings  from  settling  in  the  earth  beneath. 

13.  No  blood-pit,  dung-pit,  offal-pit,  or  privy-well  shall  remain 
or  be  constructed  within  any  slaughter-house.  Any  one  offending 
against  this  rule  shall  be  guilty  of  creating  and  maintaining  a 
nuisance  prejudicial  to  the  public  health,  and  shall  be  required  to 
remove  the  same  within  ten  days  from  the  date  of  notice. 

1 4.  The  owners,  agents,  or  occupiers  of  all  slaughter-houses  are 
required,  during  the  months  of  June,  July,  August,  and  September, 
to  distribute  twice  in  each  week  not  less  than  twenty-five  pounds 
of  chlorid  of  lime  about  the  premises,  and  also  to  remove  the 
contents  of  any  manure-pit  or  manure  pile  on  the  premises  once  in 
each  week,  the  said  premises  and  contents  of  manure-pits  being 
hereby  declared  to  be  nuisances  prejudicial  to  the  public  health, 
unless  subject  to  frequent  disinfection  and  cleaning  as  herein  indi- 
cated. 

15.  All  constables  and  supervisors  are  enjoined,  and  all  citizens 
are  respectfully  desired,  to  give  information  to  the  State  Board  of 
Health  of  any  violation  of  the  health  laws  or  of  the  regulations  of 
the  board,  so  that  the  sanitary  measures  adopted  by  the  latter  to 
ensure  the  health  of  the  people  may  be  fully  carried  out,  and  all 
offenders  promptly  punished.1 

REGULATIONS  IN  REGARD  TO  THE   SANITARY  SUPERVISION 
OF  TRAVEL  AND  TRAFFIC. 

Upon  satisfactory  information  of  the  approach  to,  or  transit 
through,  the  Commonwealth  of  Pennsylvania  of  infected  persons 
or  goods,  it  shall  be  the  duty  of  the  secretary,  as  executive  officer 
of  the  board,  to  cause  the  same  to  be  stopped  at  the  State  line,  or, 
if  found  within  the  limits  of  the  State,  to  cause  such  persons  or 
goods  to  be  removed  from  cars,  stages,  vessels,  boats,  or  other 
conveyances,  and  securely  isolated  and  disinfected ;  and  he  may, 
if,  in  his  judgment,  the  emergency  is  such  as  to  demand  it,  call  a 
meeting  of  the  committee  on  travel  and  traffic,  to  which  his  action 
shall  be  submitted,  with  his  reasons  therefor,  in  writing.  But  in 
cases  coming  under  the  jurisdiction  of  national  or  municipal 
quarantine  authorities  he  shall  co-operate  with  said  authorities  in 
all  such  action. 

1  Section  6  of  the  act  of  June  3,  1885,  confers  upon  the  State  Board  of 
Health  power  and  authority  to  order  nuisances  to  be  abated  and  removed  in 
cities,  boroughs,  districts,  and  places  having  no  local  board  of  health.  Any 
person  violating  or  failing  to  obey  such  order  becomes  liable,  on  conviction,  to 
a  fine  of  one  hundred  dollars. 


458  QUARANTINE. 

REGULATION  OF  TRAVEL  AND  TRAFFIC. 

REGULATIONS   IN  REGARD  TO  DISINTERMENT   AND  TRANS- 
PORTATION OF  DEAD  BODIES. 

Disinterment  of  Bodies. 

Rule  I.  The  removal  of  any  body  from  its  place  of  original 
interment  is  declared  to  be  a  nuisance  dangerous  to  the  public 
health,  and  is  prohibited  unless  the  same  be  done  under  the  direc- 
tion and  by  permission  of  the  State  or  local  board  of  health. 

Rule  II.  The  above  rule  applies  as  well  to  the  removal  of  a 
body  from  one  grave  or  vault  to  another  in  the  same  cemetery  as 
to  its  removal  to  another  burial-ground  or  place. 

Rule  III.  The  removal  of  dead  bodies  from  any  burial-ground 
situated  within  the  built-up  portion  of  any  city  or  borough  is  for- 
bidden between  April  i  and  October  15. 

Rule  IV.  The  disinterment  of  the  body  of  any  person  who 
died  of  any  contagious  or  infectious  disease  is  strictly  prohibited, 
unless  by  special  authority,  and  upon  such  conditions  as  the  State 
or  local  board  of  health  may  impose. 

Rule  V.  The  disinterment  of  the  bodies  of  persons  who  have 
died  of  Asiatic  cholera,  yellow  fever,  epidemic  cerebrospinal 
meningitis  or  spotted  fever,  small-pox  or  varioloid,  diphtheria  or 
membranous  croup,  relapsing  fever,  typhus  or  ship  fever,  or  scarlet 
fever,  is  prohibited,  except  by  special  permission  of  the  State  or 
local  board  of  health;  provided,  however,  that  no  such  permit 
shall  be  granted  within  ten  years  after  the  interment  of  such  person. 

Rule  VI.  When  a  body  dead  of  any  of  the  diseases  mentioned 
in  the  preceding  rule  is  to  be  disinterred,  the  following  precau- 
tions shall  be  strictly  observed  :  (a)  No  one  shall  be  present  at 
the  disinterment  but  those  necessary  to  perform  the  labor  and 
one  male  relative  of  the  deceased.  (F)  A  hermetically  sealed 
zinc-lined  box  sufficiently  large  to  contain  the  box,  coffin,  or 
casket  already  in  the  grave  shall  be  in  readiness  to  receive  the 
latter,  (r)  When  within  six  inches  of  the  top  of  the  receptacle 
containing  the  body  the  earth  shall  be  saturated  with  0.2  per 
cent,  solution  (1  :  500)  of  the  bichlorid  of  mercury,  (d)  The 
receptacle  containing  the  remains  shall  on  no  account  be  opened, 
but  shall  be  placed  at  once  in  the  box  provided  as  above  and 
hermetically  sealed,  and  said  box  shall  not  be  opened  on  arriving 
at  the  place  of  destination. 

Transportation  of  Bodies.1 

Rule  I.  The  transportation  of  bodies  of  persons  who  shall  have 
died  from  small-pox,  Asiatic  cholera,  typhus  fever,  or  yellow  fever 
is  strictly  forbidden. 

xThe  rules  and  regulations  of  the  State  Board  of  Health  are  laws  to  be 
obeyed  by  every  individual  in  the  State. 


PENNSYLVANIA  QUARANTINE  REGULATIONS.  459 

Rule  II.  From  October  15  to  April  1  all  other  dead  bodies 
may  be  transported  without  restriction,  except  those  who  shall 
have  died  of  scarlet  fever,  typhoid  fever,  or  measles,  which  must 
be  enclosed,  as  prescribed  in  Rule  III. 

Rule  III.  From  April  1  to  October  15  all  dead  bodies,  when 
presented  for  transportation,  must  be  enclosed  in  air-tight  zinc, 
copper,  or  lead-lined  wooden  boxes,  or  in  air-tight  iron  caskets  ; 
or  if  in  any  other  form  of  coffin,  said  coffin  must  be  in  a  her- 
metically sealed  box,  enclosed  in  a  manner  satisfactory  to  the 
local  board  of  health  or  health  officer. 

Rule  IV.  No  person  or  article  which  has  been  exposed  to  the 
contagion  can  accompany  the  body. 

Rule  V.  Every  dead  body  must  be  accompanied  by  a  physician's 
certificate  of  death,  and  a  certificate  from  the  shipping  undertaker 
that  the  body  has  been  prepared  for  transportation  in  accord- 
ance with  the  rules  of  the  State  Board  of  Health  of  the  Common- 
wealth of  Pennsylvania. 

Rule  VI.  In  receiving  any  dead  body  which  has  been  shipped 
from  beyond  or  within  the  States  of  New  York,  New  Jersey,  Del- 
aware, Maryland,  West  Virginia,  or  Ohio,  or  the  Province  of 
Ontario,  the  rules  of  the  State  or  provincial  boards  of  health  of 
the  same  must  be  respected,  and  their  transit  permits  will  be 
honored  without  subjecting  the  body  to  delay,  providing  such 
rules  do  not  conflict  with  any  of  the  preceding  rules  in  these  regu- 
lations. 

REGULATION  IN  REGARD  TO  THE  INTERSTATE  NOTIFICA- 
TION OF  THE  EXISTENCE  OF  INFECTIOUS  AND  CONTA- 
GIOUS DISEASES. 

The  following  are  the  regulations  adopted  by  the  International 
Conference  of  Boards  of  Health,  at  Toronto,  October  6,  1886, 
with  slight  verbal  modifications  : 

Whereas,  It  is  necessary  for  the  protection  and  preservation  of 
the  public  health  that  prompt  information  should  be  given  of  the 
existence  of  cholera,  yellow  fever,  or  small-pox ;  be  it  resolved : 

1.  That  it  is  the  sense  of  the  National  Conference  of  State 
Boards  of  Health  that  it  is  the  duty  of  each  State  and  provincial 
board  of  health  within  whose  jurisdiction  any  of  said  diseases 
may  occur,  to  furnish  immediate  information  of  the  existence  of 
such  diseases  to  boards  of  health  of  neighboring  States  and  prov- 
inces, and  to  local  boards  of  such  States  as  have  no  central 
board,  in  which  the  duty  of  notification  shall  lie  upon  the  local 
boards. 

2.  That  upon  the  prevalence  of  rumor  of  the  existence  of  pesti- 
lential disease  in  any  State  or  province,  if  positive  definite  infor- 
mation thereon  be  not  obtainable  from  the  proper  health  authorities, 
this  conference  holds  that  the  health  officials  of  another  State  are 
justified  in  entering  the  before-mentioned  State  or  province  for 


460  QUARANTINE. 

the  purpose  of  investigating  and  establishing  the  truth  or  falsity 
of  such  reports. 

3.  That  whenever  practicable  the  investigations  undertaken 
under  the  preceding  section  shall  be  made  with  the  co-operation 
of  the  State  or  local  health  authorities. 

4.  That  any  case  which  presents  symptoms  leading  to  serious 
suspicion  of  the  existence  of  one  of  the  aforenamed  diseases  shall 
be  treated  as  suspicious,  and  reported  as  provided  for  in  cases  in 
which  the  diagnosis  is  certain. 

5.  That  any  case  respecting  which  reputable  and  experienced 
physicians  disagree  as  to  whether  the  disease  is  or  is  not  pesti- 
lential, shall  be  reported  as  suspicious. 

6.  That  any  suspected  case  respecting  which  efforts  are  made  to 
conceal  its  existence,  full  history,  and  true  nature,  shall  be  deemed 
suspicious  and  so  reported. 

7.  That  in  accordance  with  the  provisions  of  the  foregoing  reso- 
lutions, the  boards  of  health  of  the  United  States  and  Canada 
represented  at  this  conference  do  pledge  themselves  to  an  inter- 
change of  information  as  herein  provided. 

Addendum  to  regulation  in  regard  to  the  interstate  notification 
of  contagious  and  infectious  diseases,  adopted  by  the  National 
Conference  of  State  Boards  of  Health  at  Washington,  September 
8,  1887,  and  by  the  State  Board  of  Health  of  Pennsylvania,  No- 
vember 9,  1887. 

1.  All  communicable  diseases  hereinafter  mentioned,  prevalent 
in  certain  areas,  or  which  tend  to  spread  along  certain  lines  of 
travel,  shall  be  reported  to  all  State  and  provincial  boards  of 
health  within  said  areas  or  along  said  lines  of  communication. 

2.  In  the  instance  of  small-pox,  cholera,  yellow  fever,  and 
typhus,  reports  shall  be  at  once  forwarded,  either  by  mail  or 
telegraph,  as  the  urgency  of  the  case  may  demand. 

3.  In  the  instance  of  diphtheria,  scarlet  fever,  typhoid  fever, 
anthrax,  or  glanders,  weekly  reports,  when  possible,  shall  be  sup- 
plied, in  which  shall  be  indicated  as  far  as  known  the  places  im- 
plicated and  the  degree  of  prevalence. 

REGULATION  FOR  THE  BETTER  PRESERVATION  OF  THE  PUB- 
LIC HEALTH,  AND  TO  LIMIT  THE  PROGRESS  OF  EPIDEMIC 
(CONTAGIOUS  AND  INFECTIOUS)  DISEASES. 

In  virtue  of  the  powers  conferred  by  the  act  of  Assembly  of 
June  3,  1885,  Sections  5  and  6,  P.  L.  56  of  the  Laws  of  the  Com- 
monwealth of  Pennsylvania,  be  it  ordered  by  the  State  Board  of 
Health  and  Vital  Statistics  of  the  Commonwealth  of  Pennsylvania, 
and  it  is  hereby  ordered  by  the  authority  of  the  same  : 

Sec.  1.  That  whatever  is  dangerous  to  human  life  or  health, 
whatever  renders  the  air  or  food  or  water  or  other  drink  unwhole- 
some, and  whatever  building  erection  or  part  of  cellar  thereof  is 
overcrowded,  or  not  provided  with  adequate  means  of  ingress  and 
egress,  or  is  not  sufficiently  supported,  ventilated,  sewered,  drained, 


PENNSYLVANIA  QUARANTINE  REGULATIONS.  461 

cleaned,  or  lighted,  are  declared  to  be  nuisances,  and  to  be  ille- 
gal ;  and  every  person  having  aided  in  creating  or  contributing 
to  the  same,  or  who  may  support,  continue,  or  retain  any  of  them, 
shall  be  deemed  guilty  of  a  violation  of  this  regulation,  and  shall 
be  liable  to  a  penalty  of  not  more  than  one  hundred  dollars. 

Sec.  2.  No  house-refuse,  offal,  garbage,  dead  animals,  decaying 
vegetable  matter,  or  organic  waste  substance  of  any  kind  shall 
be  thrown  on  any  street,  road,  ditch,  gutter,  or  public  place ;  and 
no  putrid  or  decaying  animal  or  vegetable  matter  shall  be  kept 
in  any  yard,  house,  cellar,  or  adjoining  outbuilding  or  grounds  for 
more  than  twenty-four  hours. 

Sec.  3.  No  pig-pen  shall  be  built  or  maintained  within  one 
hundred  feet  of  any  well  or  spring  of  water  used  for  drinking 
purposes,  or  within  thirty  feet  of  any  street  or  any  inhabited 
house,  or  unless  constructed  in  the  following  manner,  viz.,  so  that 
the  floor  or  floors  of  the  same  shall  be  not  less  than  two  feet 
from  the  ground,  in  order  that  the  filth  accumulating  under  the 
same  may  be  easily  removed. 

Sec.  4.  No  privy-vault,  cesspool,  or  reservoir  into  which  a  privy, 
water-closet,  cesspool,  stable,  or  sink  is  drained,  unless  it  is  water- 
tight, shall  be  constructed,  dug,  or  permitted  to  remain  within  one 
hundred  and  fifty  feet  of  any  well,  spring,  or  other  source  of 
water  used  for  drinking  or  culinary  purposes,  unless  the  surface  of 
such  vault,  cesspool,  or  reservoir  is  at  a  lower  level  than  the  bot- 
tom of  such  well.  Earth-privies  and  earth-closets,  with  no  vault, 
pit,  or  depression  below  the  surface  of  the  ground,  shall  be  ex- 
cepted from  this  regulation,  but  sufficient  dry  earth  or  coal  ashes 
must  be  used  to  absorb  all  the  fluid  part  of  the  deposit. 

Sec.  5 .  All  sewer-drains  shall  be  water-tight. 
'  Sec.  6.   No  sewer-drain  shall  empty  into  any  lake,  pond,  dam, 
reservoir,  or  other  collection  of  water  used  for  drinking-purposes, 
or  into  any  standing  water. 

Sec.  7.  All  pipes  connecting  a  water-closet  with  a  soil  pipe 
shall  be  trapped,  each  separately,  and  close  to  the  connections 
with  each  bath,  sink,  bowl,  or  other  fixture,  unless  adequate  pro- 
vision is  made  for  downward  ventilation  through  said  water-pipes, 
in  which  case  one  trap  may  serve  for  several  fixtures. 

Sec.  8.  All  soil  pipes  shall  be  carried  at  their  full  size  through 
the  roof  and  left  open.  A  provision  shall  also  be  made  for  ad- 
mitting air  to  the  house-drain  side  of  the  main  trap,  if  such  trap 
exists. 

Sec.  9.  The  joints  in  vitrified  pipes  shall  be  carefully  cemented 
under  and  around  the  pipe,  and  the  joints  in  cast-iron  pipes  shall 
be  run  and  calked  with  lead. 

Sec.  10.  All  changes  in  direction  shall  be  made  with  curved 
pipes.     All  joints  and  pipes  shall  be  made  air-tight. 

Sec.  11.  The  following-named  diseases  are  declared  to  be  com- 
municable and  dangerous  to  the  public  health,  viz.,  small-pox 
(variola,  varioloid),   cholera  (Asiatic  or  epidemic),   scarlet  fever 


462  QUARANTINE. 

(scarlatina,  scarlet  rash),  measles,  diphtheria  (diphtheritic  croup, 
diphtheritic  sore  throat),  typhoid  fever,  typhus  fever,  yellow  fever, 
spotted  fever  (cerebrospinal  meningitis),  relapsing  fever,  epidemic 
dysentery,  hydrophobia  (rabies),  glanders  (farcy),  tuberculosis 
(consumption),  and  leprosy,. and  shall  be  understood  to  be  included 
in  the  following  regulations,  unless  certain  of  them  only  are  speci- 
fied. 

Sec.  12.  Whenever  any  householder  knows  that  any  person 
within  his  family  or  household  has  a  communicable  disease  danger- 
ous to  the  public  health,  he  shall  immediately  report  the  same  to 
the  school  board,  giving  the  street  and  number  or  location  of  the 
house. 

Sec.  13.  Whenever  any  physician  finds  any  person  whom  he  is 
called  upon  to  visit  has  a  communicable  disease  dangerous  to  the 
public  health,  he  or  she  shall  immediately  report  the  same  to  the 
school  board,  giving  the  street  and  number  or  location  of  the 
house,  on  the  receipt  of  which  report  the  said  board  shall  imme- 
diately notify  the  teacher  or  principal  of  every  school  in  the  dis- 
trict, instructing  said  teachers  or  principals  to  dispense  Avith  the 
attendance  of  all  pupils  residing  in  the  family  in  which  such  dis- 
ease exists.  No  physician  who  may,  in  good  faith  in  obedience  to 
this  regulation,  report  a  case  as  one  of  communicable  disease 
which  subsequently  proves  not  to  be  such,  shall  be  liable  to  a  suit 
for  damages  for  such  error  in  reporting.  It  shall  be  the  duty  of 
said  physician  and  of  all  other  attendants  upon  persons  affected 
with  such  diseases,  to  avoid  exposure  to  the  public  of  any  garments 
or  clothing  about  their  own  persons  that  may  have  been  subjected 
to  the  risk  of  infection. 

Sec.  14.  No  person  shall,  unless  by  permit  of  a  board  of  health, 
carry  or  remove  from  one  building  to  another  any  patient  affected 
with  any  communicable  disease  dangerous  to  the  public  health. 
Nor  shall  any  person,  by  any  exposure  of  any  individual  so  affected, 
or  of  the  body  of  such  individual,  or  of  any  article  capable  of 
conveying  contagion  or  infection,  or  by  any  negligent  act  con- 
nected with  the  case  or  custody  thereof,  or  by  a  needless  exposure 
of  himself  or  herself,  cause  or  contribute  to  the  spread  of  disease 
from  any  such  individual  or  dead  body. 

Sec.  15.  There  shall  not  be  a  public  or  church  funeral  of  any 
person  who  has  died  of  Asiatic  cholera,  small-pox,  typhus  fever, 
diphtheria,  yellow  fever,  scarlet  fever,  or  measles,  and  the  family 
of  the  deceased  shall  in  all  such  cases  limit  the  attendance  to  as 
few  as  possible,  and  take  all  precautions  possible  to  prevent  the 
exposure  of  other  persons  to  contagion  or  infection  ;  and  the  per- 
son authorizing  the  public  notice  of  death  of  such  person  shall 
have  the  name  of  the  disease  which  caused  the  death  appear  in 
such  public  notice. 

Sec.  16.  No  person  suffering  from  or  having  very  recently  re- 
covered from  small-pox,  scarlet  fever,  diphtheria,  yellow  fever,  or 
measles  shall  expose  himself,  nor  shall  any  one  expose  a  person 


PENNSYL  VANIA  QUARANTINE  REGULA  TIONS.  463 

under  his  charge  in  a  similar  condition,  in  any  public  conveyance, 
without  having  previously  notified  the  owner  or  person  in  charge 
of  such  conveyance  of  the  fact  of  such  condition  as  above  stated. 
And  the  owner  or  person  in  charge  of  such  conveyance  must  not, 
after  the  entry  of  any  person  so  infected  into  his  conveyance, 
allow  any  other  person  to  enter  it  without  having  sufficiently  dis- 
infected it. 

Sec.  1 7.  No  person  shall  let  or  hire  any  house  or  room  in  a 
house  in  which  a  communicable  disease  dangerous  to  the  public 
health  has  recently  existed,  until  the  room  or  house  and  premises 
therewith  connected  have  been  disinfected ;  and  for  the  purpose 
of  this  section,  the  keeper  of  a  hotel,  inn,  or  other  house  for  the 
reception  of  lodgers  shall  be  deemed  to  let  or  hire  part  of  a  house 
to  any  person  admitted  as  a  guest  into  such  hotel,  inn,  or  house. 

Sec.  18.  Members  of  any  household  in  which  small-pox,  diph- 
theria, scarlet  fever,  or  measles  exists  shall  abstain  from  attending 
places  of  public  amusement,  worship,  or  education,  and,  as  far  as 
possible,  from  visiting  other  private  houses. 

Sec.  19.  The  clothing,  bed-clothing,  and  bedding  of  persons 
who  have  been  sick  with  any  communicable  disease  dangerous  to 
the  public  health,  and  the  rooms  which  they  have  occupied  during 
such  sickness,  together  with  their  furniture,  shall  be  disinfected  as 
directed  in  the  circulars  of  this  board. 

Sec.  20.  No  animal  affected  with  a  communicable  disease 
dangerous  to  the  public  health  shall  be  brought  within  the  limits 
of  this  Commonwealth ;  and  the  bodies  of  such  animals  dead  of 
such  disease  or  killed  on  account  thereof  shall  be  buried  with 
quicklime  under  4  feet  of  earth  or  burned,  but  shall  not  be  buried 
within  500  feet  of  any  residence  or  of  any  source  of  water-supply. 

Sec.  21.  No  milk  which  has  been  watered,  adulterated,  reduced, 
or  changed  in  any  respect  from  its  natural  condition  by  the  addi- 
tion of  any  foreign  substance  shall  be  held,  kept,  or  offered  for  sale. 

Sec.  22.  No  meat,  fish,  birds,  fowls,  fruit,  vegetables,  milk,  and 
nothing  for  human  food,  not  being  then  healthy,  fresh,  sound, 
wholesome,  fit,  and  safe  for  such  use,  nor  any  animal  or  fish  that 
died  by  disease,  and  no  carcass  of  any  calf,  pig,  or  lamb  which  at 
the  time  of  its  death  was  less  than  three  weeks  old,  and  no  meat 
therefrom,  shall  be  brought  within  the  limits  of  this  Common- 
wealth nor  offered  or  held  for  sale  as  food. 

Sec.  23.  It  shall  be  the  duty  of  the  occupant  of  even'  house, 
in  the  month  of  May,  in  each  and  even^  year,  to  clean  the  cellars 
thereof  of  all  dirt,  vegetables,  and  other  impure  matter  calculated 
to  engender  disease,  and  to  cause  them  to  be  thoroughly  white- 
washed with  fresh  lime. 

Sec.  24.  No  pupil  shall  be  allowed  to  attend  the  public  schools 
in  this  Commonwealth  who  has  not  been  vaccinated  successfully 
within  seven  years. 

Sec.  25.  No  parent,  guardian,  or  master,  in  whose  house  or 
family  there  shall  have  been  a  communicable  disease  dangerous 


464  QUARANTINE. 

to  the  public  health,  shall  permit  any  child  residing  in  said  house 
or  family  to  attend  any  public,  private,  or  Sunday  school,  after 
the  cessation  of  said  disease,  within  a  period  of  ten  days  after  the 
house  shall  have  been  thoroughly  disinfected  and  cleaned.  And 
it  shall  be  the  duty  of  school  boards  to  have  this  section  printed 
on  cards,  mentioning  the  names  of  diseases  declared  communi- 
cable and  dangerous  to  the  public  health,  and  posted  in  every 
school-room,  and  it  shall  be  the  duty  of  each  teacher  to  read  the 
section  to  the  school  at  least  once  a  month,  and  whenever  any 
epidemic  shall  appear. 

Sec.  26.  Every  person  who  acts  as  a  sexton,  undertaker,  or 
cemetery-keeper,  or  has  the  charge  of  any  tomb,  vault,  burying- 
ground,  or  other  place  for  the  reception  of  the  dead,  or  where  the 
bodies  of  any  human  beings  are  deposited,  shall  so  conduct  his 
business  and  so  care  for  any  such  place  above  named,  as  to  avoid 
detriment  or  danger  to  public  health ;  and  every  person  under- 
taking preparations  for  the  burial  of  a  body  dead  from  communi- 
cable diseases  as  hereinbefore  enumerated  shall  adopt  the  pre- 
cautions prescribed  in  Regulation  IV.  of  this  board.  No  dead 
body  shall  be  exhumed  and  removed  between  the  months  of  May 
and  October  inclusive ;  and  no  body  dead  from  any  contagious  or 
infectious  disease  shall  be  exhumed  and  removed  unless  by  special 
authority  and  upon  such  conditions  as  the  State  Board  of  Health 
may  impose. 

Sec.  27.  Every  person  violating  any  section  of  this  regulation 
is  liable  for  every  such  offence,  upon  conviction  before  any  court, 
to  a  fine  of  not  more  than  one  hundred  dollars,  at  the  discretion 
of  the  court. 

REGULATION   FOR   THE   PREVENTION   OF   BLINDNESS. 

Whenever,  in  any  city,  borough,  village,  or  place  in  this  State 
having  no  health  authority  of  its  own,  any  nurse,  midwife,  or 
other  person,  not  a  legally  qualified  practitioner  of  medicine, 
shall  notice  inflammation  of  the  eyes  or  redness  of  the  lids  in  a 
newborn  child  under  his  or  her  care,  it  shall  be  the  duty  of  such 
person  to  report  the  same  to  some  legally  qualified  practitioner 
of  medicine  within  twelve  hours  of  the  time  the  disease  is  first 
noticed. 

REGULATION    FOR    THE     ENFORCEMENT    OF    DOMICILIARY 
QUARANTINE   AND  CLOSURE   OF  SCHOOLS. 

Whenever  the  Secretary  shall  have  satisfactory  information  that 
any  of  the  following  diseases,  viz.,  small-pox,  varioloid,  scarlet 
fever,  diphtheria,  yellow  fever,  typhus  fever,  or  Asiatic  cholera,  is 
epidemic,  or  threatens  to  become  epidemic  in  any  city,  borough, 
district,  or  place  having  no  local  board  of  health,  or  in  which  the 
sanitary  laws  or  regulations  are  inoperative,  he  shall  have  authority, 
as  executive  officer  of  the  board,  to  issue  a  proclamation  in  fhe 
name  of  the  board,  declaring  such  disease  epidemic,  and  to  order 


PENNSYLVANIA  QUARANTINE  REGULATIONS.  465 

and  enforce  such  measures  in  the  way  of  quarantine,  isolation  of 
the  sick,  vaccination,  disinfection,  and  the  closure  of  schools, 
public  and  private,  religious  and  secular,  as  in  his  judgment  may 
be  necessary  to  stamp  out  the  infection. 

REGULATION  AUTHORIZING  THE  SECRETARY  TO  PLACE,  OR 
CAUSE  TO  BE  PLACED,  PLACARDS  UPON  HOUSES  IN 
WHICH  CERTAIN  COMMUNICABLE  DISEASES  EXIST. 

Sec.  1.  Whenever  the  Secretary  shall  have  satisfactory  infor- 
mation that  any  of  the  following  diseases — cholera,  small-pox 
(variola  or  varioloid),  scarlet  fever  (scarlatina),  typhus  fever,  yel- 
low fever,  relapsing  fever,  diphtheria  (diphtheritic  croup),  mem- 
branous croup,  or  leprosy — exist  in  any  city,  borough,  district,  or 
place  having  no  local  board  of  health,  or  in  which  the  sanitary 
laws  or  regulations  are  inoperative,  he  shall  have  authority  to 
place  or  cause  to  be  placed,  in  a  conspicuous  place  or  places  upon 
or  near  the  house  or  premises  in  which  said  case  may  be  located, 
a  placard  or  placards  upon  which  shall  be  printed  in  large  letters 
the  name  of  the  disease  from  which  the  person  or  persons  in  said 
house  or  premises  may  be  suffering,  as  aforesaid,  as  the  case  may 
be  :  Provided,  That  variola  or  varioloid  shall  be  placarded  as 
small-pox,  and  that  diphtheritic  croup  and  membranous  croup 
shall  be  placarded  as  diphtheria,  and  that  scarlatina  shall  be  pla- 
carded as  scarlet  fever ;  and  said  placard  or  placards  shall  remain 
thereon  until  such  time  as  the  rules  and  regulations  established  by 
this  board  regarding  the  destruction  or  disinfection  of  infected 
bedding,  clothing,  or  other  articles  which  have  been  exposed  to 
infection,  and  the  disinfection  of  houses  and  premises  have  been 
fully  complied  with  :  Provided,  That  in  addition  to  the  placarding 
aforesaid,  or  in  lieu  of  the  same,  the  Secretary  may  place  or  cause 
to  be  placed  a  guard  or  guards  upon  said  house  or  premises. 

Sec.  2.  The  head  of  the  family  occupying  any  house  or  prem- 
ises upon  or  near  which  said  placard  or  placards  aforesaid  may  be 
placed,  shall,  upon  conviction  before  any  mayor,  burgess,  alder- 
man, police  magistrate,  or  justice  of  the  peace  of  the  city,  borough, 
or  township  in  which  said  offence  was  committed,  be  liable  for  the 
fine  or  penalty  provided  by  the  act  of  Assembly  of  June  18,  1895, 
in  any  case  where  such  placard  or  placards  are  removed,  dis- 
turbed, covered  up,  taken  down,  or  destroyed  with  his  or  her 
knowledge  or  consent  before  the  time  provided  by  Section  1  of 
this  regulation  ;  said  fine  to  be  not  less  than  five  nor  more  than 
one  hundred  dollars,  in  default  of  payment  whereof  such  person 
or  persons  so  convicted  shall  undergo  an  imprisonment  in  the 
jail  of  the  proper  county  for  a  period  not  exceeding  sixty  days. 
REGULATION  REQUIRING  BURIALS  TO  BE  AT  A  CERTAIN 
DEPTH  BELOW  THE  SURFACE  OF  THE  GROUND. 

Sec.  i.  The  burial  of  a  body  at  an  insufficient  depth  below  the 
surface  of  the  ground  is  hereby  declared  to  be  a  nuisance  preju- 
dicial to  the  public  health. 

30 


466  QUARANTINE. 

Sec.  2.  In  all  cities,  boroughs,  districts,  and  places  having  no 
local  board  of  health,  no  body  shall  be  buried  at  a  less  depth  than 
6  feet  below  the  surface  of  the  ground  in  populous  districts,  or  less 
than  4  feet  below  the  surface  of  the  ground  in  rural  districts. 

REGULATION    FOR    THE    CONTROL  AND    MANAGEMENT    OF 
PIGGERIES   IN   THE   STATE   OF   PENNSYLVANIA. 

i .  This  board  declares  the  keeping  of  pigs  an  offensive  industry. 

2.  Hog-yards  and  piggeries  will  not  be  permitted  within  200 
feet  of  any  natural  stream  or  watercourse,  and  the  drainage  of  a 
piggery  shall  in  no  case  be  permitted  to  reach  any  natural  stream 
until  said  drainage  has  been  purified. 

3.  All  pig-pens  shall  be  constructed  with  water-tight  floors,- 
either  of  plank  or  cement,  which  must  be  elevated  at  least  10 
inches  above  the  ground. 

4.  The  feeding  of  animals  dead  from  natural  causes  to  pigs  will 
not  be  allowed.  Offal  should  not  be  fed  to  pigs  for  at  least  a 
month  before  they  are  killed.  The  animals  to  be  killed  should  be 
removed  from  the  pen  where  offal  is  fed  and  should  be  fattened 
on  grain.  Offal  from  hogs  should  not  be  fed  to  hogs,  as  disease 
is  liable  to  be  communicated  to  sound  animals  in  this  way.  Offal 
from  hogs  must  be  burned  or  buried. 

5 .  All  pig-pens  must  be  daily  cleansed,  and  thus  kept  free  from 
all  offensive  odors. 

6.  Where  offal  from  slaughter-houses  is  fed  to  pigs,  the  yards 
should  be  cleaned  at  least  twice  each  week,  the  refuse  being 
buried  or  burned. 

7.  Where  garbage  or  offal  is  fed  to  pigs,  the  troughs,  basins,  or 
boxes  should  be  cleansed  and  dried  as  often  as  is  necessary  to  pre- 
vent unwholesome  odors  from  arising. 

8.  No  hog-ranch  or  piggery  for  garbage-  or  offal-feeding,  where 
more  than  fifty  head  of  swine  are  kept,  shall  be  established  or 
maintained  without  a  permit  from  a  health  authority. 

REGULATION  FOR  PREVENTING  THE  POLLUTION  OF  STREAMS 
AND  OTHER  PUBLIC  WATERS  BY  THE  REFUSE  AND  SEW- 
AGE FROM  TANNERIES. 

1.  The  throwing  or  otherwise  depositing  of  hair,  lime,  fleshings, 
trimmings,  spent  tan  bark,  and  all  other  solid  waste  from  tanneries 
in  streams,  ponds,  lakes,  or  other  public  waters  is  absolutely  pro- 
hibited, as  entirely  unnecessary,  and  because  under  certain  con- 
ditions it  becomes  injurious  to  the  public  health. 

2.  All  sewage  produced  by  washing  hides  in  any  and  all  proc- 
esses, as  well  as  all  spent  tan  liquors,  shall,  before  being  run  into 
streams  or  other  waters  used  as  public  water-supplies,  be  filtered 
through  beds  of  gravel.  This  can  readily  be  accomplished  by 
setting  the  works  a  short  distance  back  from  the  water. 

3.  In  cases  where  sulphuric  acid,  chromic  acid,  or  other  acids 
or  salts  injurious  to  public  health  are  employed  in  tanneries,  they 


HOUSE  QUARANTINE.  467 

shall  be  recovered  or  neutralized  before  being  thrown  into  any 
stream  used  as  a  public  water-supply. 


REGULATION    FORBIDDING   THE   DUMPING    OF    NIGHT-SOIL 
IN    PUBLIC   WATERS. 

The  dumping  of  night-soil  in  any  river,  stream,  lake,  pond,  or 
other  public  water  in  this  Commonwealth  constitutes  a  nuisance 
prejudicial  to  the  public  health,  and  is  hereby  forbidden. 

House  Quarantine.— House  quarantine  differs  con- 
siderably in  different  States  and  cities.  The  statutes  of 
New  York  define  as  quarantinable  "yellow  fever,  measles, 
cholera,  typhus  fever,  small-pox,  scarlet  fever,  diphtheria, 
relapsing  fever,  and  any  disease  of  a  contagious,  infec- 
tious, or  pestilential  character,  which  shall  be  considered 
by  the  health  officer  dangerous  to  the  public  health." 

In  New  York  City  every  case  of  contagious  disease 
reported  to  the  health  department  is  regularly  inspected 
by  the  medical  inspector  assigned  to  the  district  in  which 
it  occurs.  When  consent  can  be  obtained,  the  cases  are 
removed  to  the  department  hospitals.  In  the  tenement- 
house  districts  an  effort  is  always  made  to  induce  patients 
suffering  from  such  diseases  to  enter  the  hospitals,  and, 
if  the  conditions  are  such  as  to  require  it,  removal  to  the 
hospitals  is  enforced.  After  completion  of  the  illness  or 
transfer  of  the  patient,  thorough  disinfection  is  made 
of  the  house  or  apartment,  and  all  infected  materials  are 
removed  to  the  disinfecting  station  for  destruction  or 
disinfection  by  steam,  when  they  are  returned  to  the 
owner.  No  charge  is  made  for  these  services,  and  disin- 
fection  is  compulsory  in  every  case.  The  practice  in 
Philadelphia  and  other  large  cities  is  quite  similar  to  that 
in  New  York. 

The  infectious  diseases  in  which  notification  is  com- 
pulsory in  Philadelphia  are:  Cholera,  small-pox,  diph- 
theria, diphtheritic  croup,  membranous  croup,  scarlet 
fever,  typhoid  fever,  typhus  fever,  epidemic  cerebrospinal 
fever,  relapsing  fever,  and  leprosy.  Knowledge  of  cases 
of  diphtheria  reaches  the  department  of  health  through 


468  QUARANTINE. 

the  forwarding  of  a  culture  to  the  bacteriologic  laboratory 
for  examination,  as  well  as  by  notification  by  the  physi- 
cian. If,  on  examination,  the  culture  is  found  to  con- 
tain diphtheria  bacilli,  the  case  is  at  once  reported  to  the 
medical  inspector,  at  the  same  time  that  a  report  is  for- 
warded to  the  attending  physician.  In  this  manner 
doubtful  cases  are  diagnosed  early,  and  no  hardships  are 
entailed  upon  the  suspect  or  the  family,  while  the  com- 
munity is  protected  by  prompt  isolation  of  all  such  cases. 
The  contagious  character  of  tuberculosis  in  all  its  forms 
is  becoming  more  and  more  generally  recognized.  Never- 
theless there  is  strenuous  opposition  from  many  sources 
to  the  notification  of  cases  of  tuberculosis.  In  New 
York  and  Philadelphia  such  notification  is  now  required, 
not  with  the  idea  of  quarantining  the  cases,  but  in  order 
to  keep  informed  as  to  their  location,  and  to  make  it 
possible  to  direct  approved  prophylactic  measures  against 
the  spread  of  the  disease  from  the  sick  to  the  well.  No 
general  disinfection  of  the  premises  occupied  by  cases  of 
tuberculosis  in  the  tenement  district  is  attempted.  On 
the  other  hand,  all  such  premises  are  thoroughly  reno- 
vated after  the  removal  or  death  of  the  tubercular 
patient.  In  this  manner  the  danger  from  infection 
through  infective  dust  is  greatly  lessened.  The  work  of 
the  department  is  hampered,  however,  because  of  the 
absence  of  sufficient  hospital  accommodations  for  con- 
sumptive poor.  Most  beneficial  effects  have,  however, 
already  resulted  from  the  various  measures  instituted  for 
the  prevention  of  tuberculosis,  as  shown  in  the  very  ma- 
terial decline  in  the  number  of  deaths  occurring  from  it. 
The  investigations  of  Anders  and  of  Flick,  of  Phila- 
delphia, and  those  of  Biggs,  of  New  York,  show  that 
tuberculosis  is  not  uniformly  diffused  through  a  com- 
munity, not  even  in  those  localities  where  it  occurs  most 
frequently,  but  is  confined  largely  within  narrow  bound- 
aries, as  in  certain  streets  and  within  the  walls  of  certain 
houses.  These  investigations  have  shown  that  when  a 
house  is  once  infected,  repeated  cases  are  developed  in  it 


HOUSE  QUARANTINE.  469 

from  the  new  tenants  occupying  such  a  house.  These 
infected  houses  are  most  frequently  found  in  the  narrower 
streets,  in  courts,  and  in  alleys.  Though  there  is  some 
danger  of  infection  from  the  inhalation  of  dust  in  the 
open  air  in  crowded  parts  of  the  city,  it  seems  probable 
that  a  more  prolonged  exposure  to  a  concentrated  atmos- 
phere of  infection,  as  found  in  these  infected  houses,  is 
the  most  frequent  mode  of  contracting  the  disease.  The 
dust  in  street-cars  and  various  public  places  is  often 
infected,  and  may  lead  to  contraction  of  the  disease. 
The  prohibition  of  spitting  on  the  floor  of  cars,  ferry- 
boats, and  other  public  conveyances  should,  therefore, 
be  strictly  enforced  as  a  wise  sanitary  measure. 


CHAPTER   XX. 
VITAL   STATISTICS. 

Vital  statistics  includes  the  records  of  all  circum- 
stances affecting  the  production  and  duration  of  human 
life,  and  corresponds  to  the  term  "  demographie  "  em- 
ployed by  French  writers.  The  registration  of  vital 
statistics  includes  the  obtaining  of  records  of  births, 
deaths,  marriages,  and  disease.  The  comparison  of  these 
records  with  each  other,  and  with  the  statistics  of  the 
living  population,  comprises  vital  statistics  proper. 

The  systems  of  registration  employed  by  different 
States  and  cities  differ  as  to  details.  They  include  a 
periodical  report  of  the  births,  with  date  and  place  of 
birth,  sex,  color,  and  nationality  of  the  child,  and  the 
names,  residence,  birthplace,  age,  and  occupation  of  the 
parents.  These  reports  are  usually  made  monthly  by 
the  physician  to  the  health  bureau  of  cities.  Deaths  are 
reported  through  the  physician  and  undertaker  to  the 
health  authorities,  who  issue  a  burial  permit.  The  in- 
formation furnished  on  the  death  certificate  includes  the 
age,  sex,  color,  nationality,  and  conjugal  condition  of 
the  deceased,  as  well  as  the  immediate  and  remote  cause 
of  death.  In  the  United  States  the  physician  acts  in  a 
judicial  capacity  in  reporting  a  death.  Upon  this  fact 
is  based  the  right  of  legislation  regulating  the  education 
and  qualification  of  medical  men  and  the  laws  regulating 
the  practice  of  medicine.  He  is  a  State  officer  in  relation 
to  his  knowledge  of  the  cause  of  death. 

The  cases  of  infectious  diseases  are  reported  at  once  by 
the  physician  when  the  diagnosis  has  established  the 
nature  of  the  disease.  Up  to  the  present  time  only  a 
few  States  have  had  an  accurate  system  of  registration. 
With  the  beginning  of  the  twentieth  century  a  number 

470 


VITAL  STATISTICS.  471 

of  States  and  cities,  as  well  as  a  large  number  of  other 
countries,  will  adopt  a  uniform  system  of  classification 
of  the  causes  of  death,  known  as  the  Bertillon  system. 
This  system  has  been  adopted  generally  after  repeated 
conferences  extending  over  a  number  of  years.  Dr.  Ber- 
tillon presented  his  system  of  classification  to  the  Inter- 
national Statistical  Institute  at  Chicago  in  1893.  It  has 
since  received  the  endorsement  of  the  American  Public 
Health  Association,  the  International  Conference  of  State 
and  Provincial  Boards  of  Health  of  North  America,  and 
received  its  first  International  Decennial  Revision  at 
Paris  in  1900.  By  the  use  of  this  uniform  system  of 
classification  the  vital  statistics  of  different  countries  will 
be  readily  comparable.  It  is  safe  to  presume  that  the 
general  adoption  of  such  a  uniform  system  of  classifica- 
tion, with  decennial  revisions  of  the  same  by  those  using 
it,  will  lead  to  more  efficient  registration  methods 
wherever  the  system  is  employed.  Full  information  as 
to  the  details  of  the  Bertillon  system  of  classification  may 
be  found  in  the  publications  of  the  American  Public 
Health  Association,  of  the  Michigan  Division  of  Vital 
Statistics,  and  the  United  States  Marine-Hospital  Service. 
Requiring  a  permit  for  burial  is  the  only  reliable  means 
of  obtaining  the  desired  information.  This  is  necessary 
to  secure  a  proper  inheritance  of  property.  It  also  aids 
in  detecting  crime. 

By  means  of  an  accurate  system  of  registration  a*  com- 
munity is  able  to  keep  informed  as  to  the  condition  of  the 
public  health,  the  efficiency  of  quarantine  measures,  the 
purity  of  the  water-supply,  and  the  death-rate  from  all 
diseases.  The  value  of  estimates  made  from  vital  statis- 
tics as  reported  to  the  health  authorities  is  dependent 
upon  a  knowledge  of  the  living  population.  In  most 
countries  this  is  determined  decennially  by  means  of  a 
national  census.  Some  cities  have  an  additional  census 
taken  midway  between  the  decennial  censuses.  In  the 
absence  of  such  special  censuses  the  calculations  are 
based    on  the   results  of   the  decennial    censuses.     The 


472  VITAL  STATISTICS. 

Registrar-General  of  Scotland  employs  the  following 
method  for  calculating  the  population  for  the  inter-census 
years:  He  assumes  that  the  rate  of  increase  as  ascertained 
from  the  two  enumerations  immediately  preceding  con- 
tinues the  same  during  the  course  of  the  next  ten  years. 
The  sanitary  department  of  Glasgow  ascertains  the  num- 
ber of  houses  inhabited  by  the  census  population,  the 
average  population  per  house,  and  then  in  each  succeeding 
inter-census  year  applies  this  average  as  a  multiplier  to 
the  inhabited  houses  for  the  year,  as  entered  upon  the 
rolls  of  the  assessor.  Neither  of  these  methods  gives 
accurate  results.  Since  population  increases  in  geo- 
metric proportion,  the  arithmetical  mean  may  be  taken 
between  two  censuses.  The  result  will  generally  be  less 
than  normal,  but  will  not  vary  more  than  i  per  iooo  in 
the  death-rate  as  calculated  from  these  data  as  compared 
with  the  results  obtained  from  actual  enumerations. 

The  Census  as  a  Basis  for  Calculation. — It  is 
essential,  therefore,  that  an  accurate  census  of  the  popula- 
tion be  taken  at  stated  intervals  to  form  the  basis  of  cal- 
culation of  the  results  obtained  from  registrations  of 
births,  deaths,  marriages,  and  disease.  The  density  of 
population,  or  the  number  of  persons  occupying  a  definite 
area,  is  also  of  value,  and  this  is  obtained  by  dividing 
the  population  by  the  area  in  square  meters,  square  miles, 
or  in  acres. 

Standards  of  Age -distribution. — In  order  to  make 
it  possible  to  secure  fair  comparisons  of  the  death-rates 
of  different  places,  a  uniform  standard  should  be  adopted 
to  which  all  populations  may  be  referred,  or  with  which 
they  may  be  compared.  The  committee  on  nomencla- 
ture of  the  American  Public  Health  Association,  in  its 
report  for  1895,  states  that,  other  things  being  equal,  a 
city  in  which  the  persons  living  under  one  year  of  age, 
and  those  who  are  more  than  fifty  years  of  age,  constitute 
together  more  than  15  per  cent,  of  the  population,  will 
have  a  higher  death-rate  than  another  city  under  similar 
conditions  in  which  the  persons  of  these  ages  constitute 


STANDARDS  OF  AGE-DISTRIBUTION.  473 

less  than  10  per  cent,  of  the  population,  since  the  death- 
rate  at  these  age-periods  is  invariably  much  higher  than' 
that  of  the  remaining  population,  constituted  as  it  is  of 
children  who  have  passed  the  first  and  most  critical  year 
of  infancy,  together  with  the  vigorous  population  of  early 
adult  life.  For  example,  in  the  comparatively  new  popu- 
lations of  such  States  or  territories  as  Arizona,  Nevada, 
Idaho,  and  the  older  state  of  Iowa,  the  ratios  of  persons 
of  the  two  age-groups,  under  one  year  and  all  over  fifty, 
were  as  follows,  by  the  census  of  1880: 

Per   Cent,    of   Persons  under   One   and  over   Fifty  Years   to    the 
Total  Population. 

Arizona 8.90  per  cent. 

Idaho      12.64       " 

Nevada 10.52       " 

Iowa J3-99       " 

On  the  other  hand,  the  per  cent,  of  persons  living  at 
these  age-periods  in  the  two  older  States  of  Delaware  and 
Vermont  was  as  follows: 

Delaware ^S-92  Per  cent. 

Vermont 21.85         " 

Now,  since  the  death-rate  of  children  under  one  year 
is  usually  from  eight  to  ten  times  as  great  as  that  of  the 
total  population,  and  that  of  persons  over  fifty  is  usually 
not  far  from  twice  as  large,  it  follows  that,  other  things 
being  equal,  we  may  expect  to  find  a  general  death-rate 
in  these  older  States  correspondingly  greater  than  that  of 
the  newer  communities." 

The  committee  advocated  the  adoption  of  the  method 
recommended  by  Korosi,  of  Budapesth,  as  being  the 
most  simple,  the  least  cumbrous,  and  the  one  that  is  suf- 
ficiently accurate  for  the  purposes  for  which  it  is  designed. 
Korosi' s  method  comprises  a  division  into  four  age-groups, 
as  follows:  Under  one  year,  one  to  twenty  years,  twenty 
to  fifty  years,  all  over  fifty  years. 

Korosi  also  recommends  that  the  age-distribution  of 


474 


VITAL  STATISTICS. 


only  one  country,  for  example,  that  of  Sweden,  be  em- 
ployed as  standard.  The  distribution  of  Sweden  by  the 
census  of  1880  was  as  follows: 

Age-period.  Per  cent. 

Under  one  year 2.65 

One  to  twenty  years 39-8l 

Twenty  to  fifty  years 38.62 

All  over  fifty 18.92 

The  method  of  application  is  as  follows,  as  applied  to 
Massachusetts: 


Age-groups. 

Standard  distribution, 
Sweden,  1880. 

Death-rate,  Massachu- 
setts, 1880. 

Mortality  index.' 

O-I 
I-20 

20-50 

all  over  50 

2.65 
39.81 
38.62 
18.92 

19.13  per  cent. 
1.28    "      " 
1.03    "      " 
3.90    "      " 

5-07 
5-°9 
3-98 
7-38 

IOO.OO 

21.52 

In  Dr.  Ogle's  standard,  which  is  in  use  in  England, 
the  population  is  divided  into  twelve  age-groups.  These 
groups,  and  the  annual  rate  of  mortality  in  England  per 
1000  persons  living,  are  shown  in  the  following  table  from 
the  Registrar-General's  report  for  i< 


All 
ages. 

0 
to 
5 

5 
to 
10 

10 
to 

15 

IS 
to 
20 

20 
to 
25 

25 
to 
35 

35 
to 
45 

45 
to 

55 

55 
to 
65 

65 
to 

75 

75 
to 
85 

85  and 
upward. 

England,    average  ~| 
annual    rate    in  1 
twenty-five    yrs.  ( 
1848-72.                   J 

22.4 

67.9 

8-3 

4.8 

6.7 
4.8 

8.8 

9-9 

7-7 

12.7 
11. 5 

17.0 
16.0 

30.1 
30.4 

62.0 
61.2 

139.6 

294.2 

England,  1880   .   .    . 

20.5 

64.4 

6-3 

3-3 

6.1 

i3J-3 

257-9 

The  rate  at  each  age-group  is  corrected  to  the  propor- 
tion of  the  population  at  that  age.  The  division  into 
twelve  age-groups,  instead  of  four,  increases  the  labor  of 
computation  threefold. 

Calculation  of  the  Birth-rate  and  Death-rate.— 
The  birth-rate  and  the  death-rate  are  both  calculated  at 


BIRTH-RATE  AND  DEATH-RATE.  475 

an  annual  rate  per  1000  of  population.  The  births  may- 
be divided  into  several  groups  according  to  sex,  race,  or 
as  regards  legitimate  and  illegitimate  births.  Death-rates 
are  of  special  value  when  calculated  for  different  occupa- 
tions, different  diseases,  and  different  age-groups.  This 
information  is  of  value  because  it  indicates  the  occupa- 
tions most  injurious  to  health,  and  also  the  ages  at  which 
most  deaths  occur.  Death-rates  from  the  various  ex- 
anthemata are  also  of  special  importance,  because  the 
course  of  an  epidemic  can  be  traced  by  this  means;  its 
relative  severity  can  be  compared  with  preceding  epi- 
demics; and  especially  the  value  of  compulsory  vaccina- 
tion can  be  ascertained  from  the  statistics  of  small-pox. 
The  following  formula  is  readily  remembered,  and  will 

facilitate  the  calculation  of  death-rates:  M  =  — -  —  ex- 
pressed in  thousands,  where  M  =  the  mortality,  D  =  the 
number  of  deaths,  and  P  =  the  population. 

Example. — In  a  population  of  2000  there  are  30  deaths, 

hence  the  death-rate  is  - —       — 3_  =  Ir  per  1000  of pop- 

2000 

ulation.  The  death-rate  from  a  particular  disease  is 
expressed  as  so  many  per  10,000  of  population,  and  the 
fatality  of  a  disease  is  expressed  in  per  cent,  of  the  num- 
ber of  cases.  The  death-rate  of  a  place  is  also  influenced 
by  other  than  the  sanitary  conditions  of  a  place,  such  as 
the  prevailing  diseases  of  the  locality,  the  nature  of  the 
occupations,  the  relative  ages  of  the  population,  etc. 

Rate  of  Infant  Mortality. — The  rate  of  infant  mor- 
tality is  measured  by  the  proportion  of  deaths  of  infants 
under  one  year  of  age,  to  the  number  of  births  registered, 
and  is  expressed  as  so  many  per  1000  births.  Stillbirths 
are  excluded.  The  infant-mortality  is  considered  to 
be  one  of  the  best  tests  of  the  sanitary  condition  of  a 
locality,  though  this  cannot  apply  to  newly  settled  locali- 
ties, where  the  infant  population  is  necessarily  quite 
small. 

Death-rate  of  Persons  Engaged  in  Various  Occu- 


476  VITAL  STATISTICS. 

pations. — The  influence  of  occupation  can  be  definitely 
determined  only  by  studies  of  the  death-rate  of  persons 
following  those  occupations,  and  this  is  done  by  deter- 
mining the  ratio  of  deaths  at  each  age  to  those  living 
during  a  certain  time  and  engaged  in  the  same  occupa- 
tion. 

Mortality  in  Relation  to  Seasons. — The  influence 
of  the  weather  in  favoring  the  production  of  certain  dis- 
eases is  shown  in  the  death-rate  from  those  diseases  at 
certain  seasons  of  the  year;  thus  in  winter  there  are  a 
greater  prevalence  and  a  higher  death-rate  from  diseases 
of  the  respiratory  system,  while  in  summer  there  are  a 
greater  prevalence  and  a  higher  death-rate  from  diseases 
of  the  gastro-intestinal  tract.  As  a  rule,  the  mortality  is 
highest  during  the  winter  months,  though  where  there  is 
a  large  infant  population  the  death-rate  is  frequently 
highest  in  summer  because  of  the  prevalence  of  infantile 
diarrhea. 

Mean  Age  at  Death. — The  mean  age  at  death  of  a 
population  is  the  sum  of  the  ages  divided  by  the  number 
of  deaths.  Due  corrections  must  be  made  for  age  and 
sex  distribution  if  these  are  not  in  accord  with  those  of 
the  o-eneral  population.  A  large  infant  population  will 
reduce  the  mean  age  at  death  though  the  health  of  the 
adult  population  is  extremely  good.  De  Chaumont  gives 
the  following  formula  for  the  approximate  calculation  of 

the  mean  duration  of  life:    {  -  X    —  |  +  (  -  X  —  |=x 

\  3        D  /       \  3       B  ' 

where  B  =  the  birth-rate,  D  =  the  death-rate  pei  unit 
of  population  (i.  e.,  35  per  1000  =  0.035  per  unit). 

Example. — In  England  between  1871  and  1880  B  = 
35.35  per  1000  =  0.03535  per  unit  of  population.  D,  for 
the  same  period,  =  21.4  per  1000  =  0.0214  per  unit  of 


1    X  -^ 


population,  then  x  =  ('  -    X  j   +  ( 

\3         0.0214/         \3         °-°3535/ 
=  40.58  vears  =  the  expectation  of  life  at  birth. 

Mean  Duration  of  I/ife. — The  mean  duration  of  life 
is  the  expectation  of  life  at  birth,  and  at  any  other  age  it 


EXPECT  A  TION  OF  LIFE. 


477 


is  expectation  of  life  at  that  age,  as  taken  from  life  tables, 
added  to  the  age. 

Probable  Duration  of  I4fe. — The  probable  duration 
of  life  is  the  age  at  which  a  given  number  of  children 
born  at  the  same  time  will  be  reduced  to  half  the  number. 

Expectation  of  I4fe.— The  expectation  of  life  is  the 
average  length  of  time  a  person  of  any  age  may  be  ex- 
pected to  live.  This  is  computed  from  life  tables.  The 
following  life  table  gives  the  results  of  computations 
from  the  mortality  returns  in  England  and  America,  and 
the  results  of  the  experiences  of  life  insurance  companies: 


/.  — 

> 

m-  1 

~ 

0' 

p' 

3 

<e 

^ 

B  °2 

1 

5. 

a 

a 

CO 

lE*-' 

00 

ri'- 

5 

0 

2 

00 

y  'f 

00 

S  a 

\ 

-a 
a 

v»w 

4 

I  :. 

i 

-s 

£* 

"3o  » 

O  Ml 

0. 

1>    V 

53 

>> 

3  w 

3   5 

-  o, 

c 

CI 

e 

s 

H 

S 

"-> 

Age. 

Males. 

Females. 

Males. 

Females. 

Males. 

Females. 

Males. 

Females. 

Males. 

Females. 

o  yr. 

41-35 

44.62 

41.92 

45-25 

41-74 

43-50 

63-5I 

59-63 

i     " 

48.05 

50.14 

48.64 

5° -75 

49.84 

50.24 

68.33 

63-57 

2  yrs. 

50.14 

52.22 

50-73 

52.81 

52.17 

52.35 

69.58 

64.24 

3    " 

50.86 

52-99 

51-45 

53-57 

52.76 

52.89 

69.78 

64.07 

4    " 

51.01 

53-2° 

51.61 

53-77 

52-93 

53.00 

69.72 

63-73 

5    " 

50.87 

53-o8 

51-47 

53-65 

52.78 

52.88 

69.36 

63  20 

■      10     " 

47.60 

49.76 

48.16 

50-32 

49.99 

48.05 

49.92 

50.04 

65-99 

59-84 

15    " 

43-94 

46-I5 

46.57 

44 

19 

45.86 

46.08 

6i-75 

55-39 

20    " 

39-4° 

41.66 

39.86 

42.10 

43-07 

40 

82 

42.17 

42.78 

57-44 

50.93 

25    " 

36.05 

38.36 

39-49 

37 

80 

39.04 

39.78 

53-24 

46.65 

3°    " 

32.10 

34-41 

32-47 

34-75 

35-85 

34 

89 

35-68 

36.70 

49.22 

42.62 

35     " 

28.88 

31.12 

32-!7 

31 

78 

32.32 

33.63 

44-74 

3847 

40 

25-30 

27.46 

25-59 

27.68 

28.48 

28 

48 

28.86 

30.29 

40.30 

34-31 

45    " 

22.34 

24.21 

24.82 

25 

02 

25.41 

26.95 

35-83 

30.43 

50    " 

18.93 

20.68 

19.14 

20.80 

21.24 

21 

33 

22.02 

23.50 

31.10 

26.30 

55     " 

16.09 

17-37 

17.80 

17 

73 

18.63 

20.05 

26.74 

22.30 

60    " 

I3-T4 

14.24 

13  3i 

14-32 

14.56 

14 

37 

15.60 

16.91 

25-52 

18.45 

65     " 

10.79 

11.55 

11.60 

11 

31 

12.57 

13-77 

1893 

15-23 

70    " 

8.27 

8.95 

8.44 

9.08 

8.17 

8 

12 

10.32 

11.30 

15.25 

12.82 

75    " 

6.52 

7.04 

6.72 

6 

34 

8.08 

8.83 

12.61 

11.07 

80    " 

4-79 

5.20 

4.96 

5-38 

4.87 

4 

49 

6.86 

7-37 

10.35 

9.07 

85    " 

3-78 

4-T5 

3-4o 

3 

.08 

5-63 

5.91 

7- 5o 

7.50 

90    " 

2.84 

2.90 

2.88 

3.16 

2.17 

2 

05 

95    " 

2.17 

2.17 

2.20 

2.40 

i-34 

1 

34 

100    " 

1.68 

1.76 

1.72 

1.84 

In  order  to  construct  such  a  table,  we  must  know  the 
number  of  persons  living,  their  ages,  the  number  of 
deaths,  and  the  ages  at  death,  and  changes  in  population 
caused  by  unusual  birth-rate,  by  emigration,  immigration, 
and  other  causes. 


478  VITAL  STATISTICS. 

The  expectation  of  life  of  females  is  greater  than  that 
of  males  according  to  the  results  obtained  in  Bngland 
and  in  Massachusetts.  The  reverse  is  the  case  with  the 
Jews  of  the  United  States.  In  the  experience  of  the 
thirty  life  insurance  companies  of  America  the  expecta- 
tion of  life  of  males  is  greater  than  that  of  females.  This 
most  interesting  result  obtained  from  the  selected  lives 
of  the  insured  is  difficult  to  explain.  The  relatively 
greater  number  of  males  insured  may  explain  this  differ- 
ence in  the  result. 

The  results  obtained  in  England  and  Massachusetts 
indicate  that  the  female  mortality  is  lower  than  the  male 
mortality,  and  it  is  evident,  therefore,  that  the  dangers 
connected  with  childbearing  do  not  prevent  the  general 
female  mortality  at  childbearing  ages  from  being  lower 
than  that  of  males. 

The  causes  of  the  higher  mortality  among  males  are 
largely  connected  with  the  greater  hardships  and  dan- 
gers connected  with  their  occupations.  In  spite  of  the 
dangers  of  childbirth,  married  women  have  a  much  lower 
mortality  than  spinsters  or  widows.  Widows  of  twenty 
to  twenty-five  years  of  age  have  a  higher  mortality  than 
bachelors  and  married  men  of  the  same  a»e. 

o 

The  expectation  of  life  after  the  first  year  increases  up 
to  the  fourth  year,  and  remains  higher  than  at  the  first 
year  up  to  about  the  seventeenth  year.  Willich  gives 
the  following  formula  for  the  approximate  calculation 
of  the  expectation  of  life  at  any  age:  Expectation  of 
life  =  -|  (80  —  a)  =  ;r,  where  a  =  the  present  age,  and  x  = 
the  expectation  of  life.  Thus  at  forty  years,  f  X  (80  — 
40)  =  26.66  years. 

Relation  of  Density  of  Population  to  the  Death- 
rate.— The  relation  of  the  density  of  the  population  to 
the  death-rate  is  most  important.  Dr.  Farr  found  that 
the  mortality  increases  with  the  density  of  the  popula- 
tion, but  not  in  direct  proportion  to  the  density,  but  as 
its  sixth  root.  Thus  if  D  and  D'  =  density  of  the  popu- 
lation in  two  places,  and  M  and  M'  the  mortality,  then 


NECESSITY  OF  SYSTEM  OF  NO TIFICA  TION.    479 

M'  _    6TTj' 

jz-  —  \~jz      The  death-rate  in  each  locality  is,  however, 

influenced  by  other  factors  than  the  mere  fact  of  the 
existence  of  a  certain  number  of  persons  in  a  specified 
area.  The  most  important  factors  which  influence  the 
death-rate  under  all  conditions  are  the  proportion  which 
the  infant  population  bears  to  the  whole,  or,  in  other 
words,  the  average  age  of  the  population,  the  nature  of 
the  occupation  of  the  people,  and,  above  all,  the  general 
sanitary  conditions  of  the  surroundings. 

Necessity  of  System  of  Notification. — Vital  statis- 
tics cannot  be  obtained  without  some  system  of  notifica- 
tion. Various  objections  have  been  raised  against  the 
notification  of  infectious  diseases.  The  objection  is 
frequently  made  that  the  friends  of  the  patient  wish  to 
keep  the  matter  secret,  and  that  notification  is  a  betrayal 
of  confidence.  There  is  usually  delay  in  calling  a  phy- 
sician, and  this  gives  opportunity  for  the  spread  of  the 
disease.  The  physician  must  be  held  responsible  for 
reporting  infectious  diseases,  otherwise  the  certainty  of 
prompt  notification  is  limited.  The  physician  should  be 
compensated  for  this  extra  work,  though  this  is  rarely 
done,  and  physicians  should  feel  it  a  privilege  to  make 
the  notifications,  because  it  is  the  right  of  only  those 
who  are  authorized  to  practise  in  a  locality.  It  is, 
therefore,  one  mode  of  protecting  the  registered  phy- 
sicians against  the  invasion  of  those  who  are  not  quali- 
fied. 

The  notification  of  infectious  diseases  frequently  causes 
great  discomfort  and  pecuniary  loss  to  those  who  are 
isolated  in  the  infected  area.  It  interferes  with  the  liberty 
and  comfort  of  a  large  number  of  people,  though  this 
discomfort  is  insignificant  to  the  general  discomfort  and 
loss  entailed  by  general  epidemics. 

Dr.  Biddle,  in  a  paper  read  before  the  Seventh  Inter- 
national Congress  of  Hygiene,  on  "Should  Compulsory 
Notification  be  made  General?"  gives  the  mean  death- 
rates  per  1000  living  in  twenty  towns  of  England: 


480 


VITAL  STATISTICS. 


1871-75. 

1876-So. 

1881-85. 

1886-90. 

All  causes       

24.81 

4-79 
2.17 

23.26 
3-84 
i-47 

21.84 
3-27 
113 

21.19 
2.91 
0.78 

Notification  has  been  in  force  since  the  adoption  of  the 
Public  Health  Act  of  1875.  While  there  was  a  decline 
in  the  death-rate  from  all  causes  from  1871-75  to  1886-90 
of  only  14.5  per  cent,  there  was  a  decline  of  39.2  per 
cent,  in  the  death-rate  from  the  total  zymotic  diseases, 
and  a  decline  of  64  per  cent,  in  the  death-rate  from  the 
notifiable  diseases  during  the  same  period,  showing  the 
great  value  of  notification  in  infectious  diseases. 

Hospital  for  Infectious  Diseases. — Where  satisfac- 
tory isolation  is  impracticable  the  city  should  provide 
special  hospitals  for  infectious  diseases.  This  arrange- 
ment lessens  the  hardships  of  isolation,  and  may  be 
instrumental,  under  proper  regulations,  in  favoring  the 
system  of  notification. 

The  special  need  of  pay  hospitals  for  infectious  diseases 
has  long  been  felt.  Even  where  the  patient  could  be 
satisfactorily  isolated  and  treated  in  the  home,  there  is  a 
feeling  that  the  pecuniary  loss  and  inconvenience  of 
house  quarantine  are  much  greater  than  the  expense  of 
hospital  treatment.  Consequently  those  that  are  able 
and  willing  to  pay  for  hospital  treatment  cannot  be 
accommodated  anywhere  except  at  the  municipal  hos- 
pital, and  there  is  frequently  objection  to  going  to  a 
public  institution.  It  is  safe  to  state  that  the  time  is  not 
far  distant  when  every  large  city  will  have  pay  hospitals 
for  the  reception  of  cases  of  infectious  diseases.  Such 
hospital  treatment  would  overcome  the  obnoxious  house 
quarantine  practised  to-day,  at  least  as  far  as  those  are 
concerned  whose  time  is  most  valuable  from  their  busi- 
ness associations. 


APPENDIX. 


Rules  for  interchange  of  different  expressions  of  results 
of  analysis  : 

To  convert  parts  per  100,000  into  grains  per  gallon 
(=  parts  per  70,000),  multiply  by  0.7. 

To  convert  grains  per  gallon  into  parts  per  100,000, 
divide  by  0.7. 

To  convert  parts  per  million,  or  milligrams  per  liter, 
into  grains  per  gallon,  multiply  by  0.07. 

To  convert  grains  per  gallon  into  parts  per  million,  or 
milligrams  per  liter,  divide  by  0.07. 

To  convert  nitrogen  as  nitrates  into  nitric  anhydrid, 
multiply  by  108  and  divide  by  14. 

To  convert  nitric  anhydrid  into  nitrogen  as  nitrates 
multiply  by  14  and  divide  by  108. 

To  convert  nitrogen  as  nitrites  into  nitrous  anhydrid, 
multiply  by  76  and  divide  by  14. 

To  convert  nitrous  anhydrid  into  nitrogen  as  nitrites, 
multiply  by  14  and  divide  by  j6. 

To  convert  free  or  albuminoid  ammonia  into  parts 
of  nitrogen  as  ammonia,  multiply  by  14  and  divide 
by  17. 

To  convert  nitrogen  as  ammonia  into  free  or  albu- 
minoid ammonia,  multiply  by  17  and  divide  by  14. 

Rules  for  the  conversion  of  degrees  of  one  thermometer 
scale  into  those  of  another  : 

Centigrade  into  Fahrenheit,  multiply  by  9,  divide  by 
5,  and  add  32. 

Fahrenheit  into  centigrade,  divide  by  9,  multiply  by  5, 
and  deduct  32. 

31  481 


482  APPENDIX. 

Fahrenheit  into  Reaumur,  divide  by  9,  multiply  by  4, 
and  add  32. 

Reaumur  into  Fahrenheit,  multiply  by  9,  divide  by  4, 
and  deduct  32. 

Centigrade  into   Reaumur,   divide  by  4  and  multiply 

by  5- 

Reaumur  into  centigrade,  divide  by  5  and  multiply 
by  4. 

Rules  for  conversion  of  kilogram-meters  into  foot-pounds 
and  foot-tons,  and  vice  versa  : 

To  convert  kilogram-meters  into  foot-pounds,  multiply 
by  7.233. 

To  convert  foot-pounds  into  kilogram-meters,  divide 
by  7.233. 

To  convert  kilogram-meters  into  foot-tons,  multiply  by 
0.003229. 

To  convert  foot-tons  into  kilogram-meters,  multiply  by 

3°9-7- 

Values  of  terms  employed  in  connection  with  fuel-value 
of  food  : 

1  calorie  =  the  amount  of  heat  required  to  warm  I  gram  of  water 
I  degree  centigrade  =  small  calorie. 

I  kilogram-calorie  =  the  amount  of  heat  required  to  warm  I  kilo- 
gram of  water  I  degree  centigrade  =  large  calorie. 

The  mechanical  equivalent  of  I  calorie  =  3100  foot-pounds. 

Comparison  of  Metric  and  English   Weights  and  Meas- 
ures : 

LENGTH. 

I  meter  =  39.37    inches  =  3.28  feet. 

I  decimeter    =    3.94         "       =4  inches,  nearly. 

1  centimeter  =    0.394    inch    =  T^~  inch. 

I  millimeter  =    0.0394     "      =  ^V     "     nearly. 

1  kilometer    =    1000  meters  =  1094  yards  =  |  mile,  nearly. 

I  mile  =     1609        "       or  1.609  kilometers. 

1  foot  =    0.3      meter   =  3.048  decimeters. 

1  inch  =  25.4  millimeters. 


APPENDIX.  483 

CAPACITY. 

I    liter  =   1000  cubic    centimeters  =  61    cubic  inches  =  35.3 

ounces  =  1.76  pints  =  0.22  gallon. 
I    cubic   centimeter  =  0.061   cubic  inch. 
1,000,000    cubic    centimeters  =   1000   liters  =   1    cubic   mefer 

=  35.3  cubic    feet. 

1   cubic  inch  =16.4   cubic  centimeters. 

1    fluidounce     =28.35   cubic   centimeters  =  1. 733  cubic  inches. 

1    cubic    foot  =    6.23  gallons  =  1000  fluidounces  =  28.3  liters. 

r  4.545  liters,  dry. 
1  gallon  =  4545   cubic   centimeters  =  j       g       u      l[quid_ 

WEIGHT. 

i  cubic  centimeter  of  water  at  40  C.  (39. 20  F.)  weighs  I  gram. 

I  gram  =  15.432    grains  =  0.0527  ounce. 

1  decigram  ==     1.5432      "      =  1^  grains,  nearly. 

I   centigram  =    o.  1 5432  grain  =  T2g  grain       " 

1   milligram  =    0.015  "      =  zt      "  " 

1  kilogram    =  1000  grams  =  15,432  grains  =  2.2046  lb.,  avoir. 

=  35-3  ounces. 
I  grain  =  65  milligrams,  nearly. 

1  ounce         =  28.35  grams. 
I   lb.,  avoir.  ==  453.5 
I  ton,  avoir.  =  1018  kilograms. 

AREA. 

I  sq.  meter  =  10.76    sq.  feet        =  1542  sq.  inches. 

1  sq.  centimeter  =  0.154    sq.  inch  =  T2y    sq.  inch,  nearly. 

I  sq.  millimeter  =  0.0015         "        =  -%\^         "  " 

IOO  sq.  meters  =  1  are  =  1 19. 7  sq.  yards  =  3.954  sq.  rods. 

IOO  ares  (hektar)  =  11,967  sq.  yards  =  2.47  acres. 

1  sq.  kilometer  =  1,000,000  sq.  meters  =  247  acres  =  0.386 
sq.  mile. 

1  sq.  inch  =  6.452  sq.  centimeters  =  645   sq.  millimeters. 

1  sq.  foot  =  0.0929  sq.  meter  =  9.29  sq.  decimeters. 

1  sq.  yard  =  0.8361         " 

I  acre  ?=  40.5  are,  nearly  0.405  =  hektar. 


INDEX. 


Abatement  and  removal  of  nuisances, 

454 
Ablution,  amount  of  water  required  for, 

106 
Absolute  humidity,  40 
Acclimation,  47 
Acid,  carbolic,  380 

carbonic,  141 

hydrocyanic,  379 

sulphuric,  141 
Action  of  wind,  64 
Adulterations  of  food,  225 
Adults,  subsistence  diet  for,  229 
Age,  19 

at  death,  mean,  476 

diet  for  old,  231 
Age-distribution,  standards  for,  472 
Agents,  physical,  for  disinfection,  382 
Air,  31 

amount  required,  59 
respired,  59 

bacteria  in  expired,  52 

chemical  analysis  of,  55 

diseases  produced  by  impure,  55 

dust  in,  54 

effects  of  solid  impurities  in,  58 

examination  of,  by  senses,  54 

ground,  48,  317 

hot,  heating  with,  89 

impure,  diseases  produced  by,  55 

impurities  in,  49 
sources  of,  49 

of  dwellings,  impurities  in,  53 

of  factories,  impurities  in,  53 

of  workshops,  impurities  in,  53 

propeller,  75 

sewer,  48 

temperature  of,  33 

vitiated,  effects  of,  56,  57 
Alcoholic  beverages,  223 
Alimentary  principles  of  food,  193 
Alkalinity  of  water,  140 
Ammonia,  free  and  albuminoid,  139 
Amount  of  air  required,  59 
respired,  59 

of  exercise  that  should  be  taken,  238 

of  food,  excessive,  232 

of  nutrients  furnished  for  twenty-five 
cents,  188 

of  water  required  daily,  106 
Analysis  of  air,  chemical,  55 

of  water  and  sewage,  133 


Analysis   of    water,   chemical    analysis, 
136 
alkalinity,  140 
carbonic  acid,  141 
chlorin,  138 
dissolved  oxygen,  141 
evaporation  residue,  138 
hardness,  140 
iron,  141 

nitrogen  as  ammonia,  139 
as  nitrates,  139 
as  nitrites,  139 
oxygen  consumed,  140 
collection  of  samples,  133 
microscopic  examination,  136 
physical  examination,  135 
quantitative    bacterial    examina- 
tion, 142 
Anemometer,  portable,  73 
Animal  foods,  195 

and  vegetable  parasites,  368 

prevention  of  infection  by,  369 
Anopheles,  362 
Appendix,  481 

Approximate  composition  of  water,  105 
Aqueous  vapor,  50 
Arrangement  in  natural  ventilation,  65 

of  interior  of  house,  324 
Artesian  wells,  no 

Articles  of  leather,  disinfection  of,  421, 
437 
to  be  burned,  389 
Artificial  ventilation,  74 

comparison  of  methods,  81 
extraction  method,  81 
propulsion  method,  81 
Asiatic  cholera,  103 

detention  of  passengers  on  account 

of  437 
disinfection  for,  435,  450 
Atmosphere,  humidity  of,  37 
movements  of,  41 
nature  and  composition  of,  31 
pressure  of,  34 
distribution  of,  36 
Attitude,  mental,  251 
Avenues  of  entrance,  358,  359 

Bacteria,  102 
in  expired  air,  52 
or  contact-bed  system,  164 
pathogenic,  in  dead  bodies,  360 

485 


486 


INDEX. 


Bacteria,     pathogenic,    persistence     in 
dead  bodies,  360 
persistence  in  soil,  320 
Bacterial  examination  of  water,  142 
Baggage  from   Cuba  and   Porto   Rico, 

422 
Baking  powders,  220 
Barometer,  34 
Barracks,  299 
Basis  for  calculation  of  vital  statistics, 

472 
Bedding,  disinfection  of,  389,  437 
Beef,  lean,  204 
Beverages,  alcoholic,  223 

non-alcoholic,  224 
Bills  of  health,  408 
Birth-rate,  calculation  of,  474 
Blackboards,  position  of,  274 
Blindness,  prevention  of,  464 
Board  of  health,  regulations  of,  454 
Bodies,  dead,  disinterment  of,  458 
pathogenic  bacteria  in,  360 
transportation  of,  458 

of  water,  self-purification  of,  112 
Body,  chemical  composition  of,  178 
Boiler-purposes,  suitability  of  water  for, 

132 
Boiling  water,  128 
Bone-boiling,  regulation  of,  455 
Bowels,  regular  attention  to,  249 
Bread,  220 
Buildings,  defects  in,  280 

loss  of  heat  from,  82 
Burials,  depth  of,  465 
Butter,  217 

adulteration  of,  226 

Cabins,  disinfection  of,  419,  436 
Cameron  septic  tank,  160 
Camp,  diseases  in,  301 
location  of,  296 
sanitary  policing  of,  296 
Camps,  295 

Canadian  frontiers,  441 
Cancer,  105 

Canned  vegetables,  adulteration  of,  226 
Capacity,  drainage,  of  soil,  269 
Carbolic  acid,  380 
Carbon  dioxid,  50,  55 

monoxid,  55 
Carbonic  acid,  141 
Card,  inspection,  416 
Cargo,  disinfection  of,  419,  424,  438,  446 

inspection  of,  412 
Causes  of  disease,  17 

exciting,  19 

immediate,  17 

predisposing,  19 

remote,  18 

vital,  332 
Census,  basis  for  calculation,  472 
Cereals,  composition  of,  219 
Chamber,    steam,    use   of  formaldehyd 

in,  426 
Cheese,  219 


Chemical  analysis  of  air,  55 
of  sewage,  136 
of  water,  136 
composition  of  air,  31 
of  body,  178 
of  water,  92 
treatment  of  sewage,  155 
Childhood,  diet  in,  229 
Chlorin,  138 
Chlorinated  lime,  381 
Cholera,  Asiatic,  103 

detention  of  passengers   on   account 

of,  437 
disinfection  for,  435,  450 
Cholera-infected   vessels,  treatment   of, 

434 
Circulation,  effect  of  exercise  on,  235 
City,  destruction  of  mosquitoes  in,  367 
Cleaning  house,  330 
Cleanliness  in  relation  to  clothing,  246 

of  mouth  and  teeth,  249 
Cleansing  the  vessel,  307 
Climate,  42 

influence  upon  health,  45 
upon  mortality,  47 
Clinical  report,  418 
Cloak-rooms,  274 
Closet,  water-,  147,  277 

amount  of  water  required  for,  106 
disinfection  of,  429 
Closure  of  schools,  464 
Clothing,  241,  309 

cleanliness  in  relation  to,  246 

disinfection  of,  389,  437 

injurious  effects  of,  245 

of  the  soldier,  292 
Clouds,  41 

Coal  filters,  Garfield,  165 
Cocoa,  adulteration  of,  226 
Coffee,  adulteration  of,  226 
Cold,  protection  against,  241 
Collection  and  removal  of  garbage,  174 

of  samples  of  water,  133 
Combination  systems  of  heating,  89 
Combustion,  effects  of  air  vitiated  by, 
57 

impurities  due  to,  52 
Commercial  value  of  sewage,  171 
Communicable      diseases,      placarding 

houses  in,  465 
Comparative  mortality,  256-258 
Comparison  of  methods  of  ventilation, 
80,  81 

of  natural  waters,  95 
Compartments,  infected,  disinfection  of, 
428 

living,  of  vessels,  425 
Composition  of  cereals,  219 

of  different  kinds  of  meat,  205 

of  drinking-water,  92,  105 

of  food  materials,  189,  192 

of  leguminosae,  219 

of  the  atmosphere,  31 
Condiments,  223,  224 
Conditions  of  environment,  hygienic,  25 


INDEX. 


487 


Configuration  of  soil,  320 

Conjugal  conditions,  24 

Connate  conditions,  23 

Consumption  of  fluids,  224 

Contact-bed  system,  164 

Contagious  diseases,  interstate  notifica- 
tion of,  459 
limitation  of,  460 

Control  of  sale  of  milk,  municipal,  212 

Conveyances,    public,    disinfection    of, 
390 

Cooking,  amount  of  water  required  for, 
106 

Correct  soles,  243 

Corridors,  274 

Corrosive  sublimate,  380 

Cost  of  food,  188 

Covering  of  floors,  325 
of  walls,  326 

Cows,  care  of,  214 

Creolin,  381 

Crew,  disinfection  of,  438 
inspection  of,  414 
personal  effects  of,  426,  438 

Cuba,  baggage  from,  422 

Cubic  space,  61,  270 

relation  to  window  space,  272 

Culex,  362 

DAILY  amount  of  water  required,  106 

diet,  minimum  standard  of,  186 
Dairy  rules,  213 

Dampness,  protection  against,  242 
Damp  soil,  improvement  of,  320 
Dark  meat,  effect  of,  203 
Dead  bodies,  disinterment  of,  458 
pathogenic  bacteria  in,  360 
transportation  of,  458 
Death,  mean  age  at,  476 
Death-rate,  calculation  of,  474 

in  different  occupations,  475 

relation  to  population,  478 
Defects  in  school-buildings,  280 
Deformed  feet,  244 
Degree  of  warmth,  82 
Density  of  population,  relation  to  death- 
rate,  478 
Desks,  278 
Destruction  of  mosquitoes  in  the  city, 

367 
Detection  of  meat  preservatives,  201 
Detention  period,  399 
of  passengers,  437 
of  personnel  of  vessels,  427,  445 
Diarrhea,  104 
Diet  for  old  age,  231 

in  childhood,  229 

in  infancy,  229 

subsistence,  for  adults,  229 
Dietaries,  228 
Dietary,  standard,  186 
Dieting,  178 

Difference  in  temperature,  64 
Different  varieties  of  food,  195 
Diffusion,  64 


Diffusion  of  gases,  59 

Digestibility  of  food,  190 

Dilution,  113 

Diphtheria,  isolation  and  disinfection  in, 

396  . 
Direct  heating,  83 
radiation,  85,  86 
Direct-indirect  radiation,  86 
Disease,  17 
among  marines,  315 
conveyed  through  milk,  206 
exciting  causes  of,  19 
immediate  causes  of,  17 
in  camp,  301 
infectious,  disinfection  in,  386 

hospitals  for,  480 

preventive  measures  for,  358,  359 
interstate  notification  of,  459 
intestinal,  disinfection  in,  386 
limitation  of,  460 
predisposing  causes  of,  19 
produced  by  diseased  meat,  196 

by  impure  air,  55 
quarantinable,  448 
remote  causes  of,  18 
respiratory,  disinfection  in,  386 
vital  causes  of,  332 
Disinfectants  in  common  use,  373 
Disinfecting  plant,  steam,  375 

solutions,  standard,  390 
Disinfection,  372,  424,  435 
and  isolation,  value  of,  395 
for  cholera,  435,  450 
for  plague,  424,  446 
for  small-pox,  451 
for  typhus  fever,  452 
for  yellow  fever,  419,  451 
instructions  for,  389 
of  bedding,  389,  437 
of  clothing,  389,  437 
of  excreta,  383 
of  habitations,  387 
of  hospitals,  428 
of  infected  compartments,  428 
of  infective  materials,  383 
of  napkins,  389 
of  patient,  388 
of  rooms,  389 
of  sick-room,  384 

in  exanthemata,  385 

in  intestinal  diseases,  386 

in  other  infectious  diseases,  386 

in  respiratory  diseases,  385 
of  towels,  389 
of  vessels,  419,  424,  435 

cabins,  419,  437 

cargo,  419,  424,  438,  446 

forecastle,  419,  436 

holds,  419,  424,  425,  435,  446 
of  iron  vessels,  424 
of  wooden  vessels,  425 

living  compartments,  425 

officers'  quarters,  419 

personal  effects,  426,  438 
of  crew,  426,  438 


488 


INDEX. 


Disinfection  of  vessels,  personal  effects 
of  passengers,  426,  438 
state-rooms,  419 
steerage,  419,  435 
water-closets,  429 

on  large  scale,  374 

preliminary,  424,  444 
Disinterment  of  dead  bodies,  458 
Disposal  of  garbage,  173,  175 

of  sewage,  147,  154,  277 
Disposition,  final,  of  vessels,  427 
Dissemination,  modes  of,  334,  358,  359 
Dissolved  oxygen,  141 

solid  impurities  in  water,  100 
Distillation  of  water,  128 
Distribution  of  atmospheric  pressure,  36 
Domestic  filter,  127 

ports,  quarantine  regulations  for,  423 

water-still,  128 
Domiciliary    quarantine,   regulation   of, 

464 
Drainage,  328 

capacity  of  the  soil,  269 
Drinking-water,  amount  required,  106 

composition  of,  105 
Dry-earth  closet,  153 
Dry  heat,  382 
Duration  of  life,  mean,  476 

probable,  477 
Dust  in  air,  54 

removal  of,  78 
Dwellings,  air  of,  53 
Dysentery,  104 

Effect  of  exercise  on  the  circulation, 

235 
on  the  elimination  of  nitrogen,  237 
on  the  lungs,  233 
on  the  muscles,  236 
on  the  nervous  system,  237 
on  the  nitrogen  elimination,  237 
Effects,  injurious,  of  clothing,  245 
of  impurities  in  water,  100 
of  light  and  dark  meat,  203 
of  solid  impurities  in  air,  58 
of  vitiated  air,  56,  57 
of  wind  upon  health,  41 
personal,    of    passengers    and    crew, 
426 
Elastic  force  of  vapor,  39 
Electricity,  heating  with,  90 
Elimination  of  nitrogen,  effect  of  exer- 
cise on,  237 
Energv  derivable  from  food,  182 

potential,  in  food,  180 
Enforcement  of  closure  of  schools,  464 

of  domiciliary  quarantine,  464 
Entrance,  avenues  of,  358,  359 
Environment,  hygienic  condition  of,  25 
Epidemic  diseases,  limitation  of,  460 
Epidemics,  nature  of,  335 
Establishments,   industrial,    lighting  of, 

265 
Etiologic  factor,  358,  359 
Evaporation  residue,  138 


Examination  of  air  by  senses,  54 
of  water,  bacterial,  142 
chemical,  136 
microscopic,  136 
physical,  135 
Exanthemata,  disinfection  in,  385 
Excessive   amounts   of  food,   influence 

of,  232 
Exciting  causes  of  disease,  19 
Excreta,  disinfection  of,  383 
Exercise,  233 

amount  that  should  be  taken,  238 
effect  on  the  circulation,  235 

on  the  elimination  of  nitrogen,  237 
on  the  lungs,  233 
on  the  muscles,  236 
on  the  nervous  system,  237 
on  the  nitrogen  elimination,  237 
Exhaust-steam  heating,  88 
Expectation  of  life,  477 
Expired  air,  bacteria  in,  52 
Extermination  of  rats,  367 
Extraction  and  propulsion  method   of 
ventilation,  80 

Factor,  etiologic,  358,  359 

Factories,  impurities  in  air  of,  53 

Fans,  75 

Fatigue,  236 

Fat-rendering,  regulation  of,  455 

Feet,  deformed,  244 

normal,  244 
Fever,  scarlet,  isolation  and  disinfection 
in,  396 

typhoid,  102 

typhus,  disinfection  in,  452 

yellow,  419 

disinfection  in,  419,  451 
of  vessels  in,  419,  446 
interstate  quarantine,  449 
prevention  of,  362 
treatment  of  vessels  in,  419,  439 
Fifty  dairy  rules,  213 
Filter  construction,  127 

domestic,  127 

mechanical,  121 

plant,  specifications  for,  122 

sand, 119 
Filtering   medium,  127 
Filters,  Garfield  coal,  165 

household,  127 

mechanical,  120 

sand,  115 
Filtration,  115 

intermittent,  116 

mechanical,  120 

purification  without,  128 

sand, 115 

through  coarse  broken  stone,  160 
Final  disposal  of  vessels,  426 
Fire,  385 

Fireplaces,  open,  86 
Fish,  205 

Flies,  protection  from,  331 
Floor  space,  270,  272 


INDEX. 


489 


Floors  and  floor  covering,  325 
Fluids,  consumption  of,  224 
Food,  adulterations  of,  225 

alimentary  principles  of,  193 

and  dieting,  178 

animal,  195 

composition  of,  192 

digestibility  of,  190 

energy  derivable  from,  182 

influence  of  excessive  amounts,  232 
of  insufficient  amounts,  231 

materials,  composition  of,  189 

mineral,  222 

nutritive  value  and  cost,  188 

potential  energy  of,  180 

preservatives,  222 

water  as,  194 
Food-supply,  308 

influence  on  milk,  210 
Foods,  adulteration  of,  225 

animal,  195 

vegetable,  218 
preserved,  221 
Foot  inspection,  302 
Forbes  water  sterilizer,  129 

army  type,  297 
Force  of  vapor,  elastic,  39 
Forecastle,  disinfection  of,  419,  435,  436 
Foreign   ports,    quarantine   regulations 

at,  408 
Formaldehyd,  376 

disinfection  with,  436,  437 

generation  of,  376 

use  of,  in  steam  chamber,  426 
Foundation  of  house,  323 
Fresh  air,  amount  required,  59 

respired,  59 
Friction,  73 
Frontiers,  Canadian,  441 

Mexican,  441 

quarantine  regulations  at,  429 
Furniture,  upholstered,  disinfection  of, 

437 
shipment  of,  414 

Game,  205 
Garbage,  173,  455 

collection  and  removal,  174 

disposal,  173,  175 
Garfield  coal  filter,  165 
Garments,  outer,  292 
Gas,    formaldehyd,    disinfection    with, 
435.  436 
generation  of,  376 

heating  by  means  of,  91 
Gaseous  impurities  in  water,  100 
Gases,  diffusion  of,  59 
General  regulations,  quarantine,  449 

requirements  at  quarantine,  434 

rules  for  ventilation,  63 
Generation  of  formaldehyd  gas,  376 
Goiter,  105 
Ground-air,  48,  317 
Ground-water,  318 

supplies,  109 


Habitations,  250,  322 

disinfection  of,  387 
Haftkine  method  of  protection,  356 
Hardness  of  water,  140 
Health,  17 
bills  of,  408 

effects  of  wind  upon,  41 
influence  of  climate  upon,  45 

of  humidity  upon,  40 
of  laborers,  264 
State  board,  regulations  of,  454 
Heat,  74 
dry,  382 

emitted  by  radiation,  84 
loss  of,  from  buildings,  82 
moist,  382 

protection  against,  242 
supplied  by  radiating  surfaces,  83 
Heating,  82,  276,  327 

by  means  of  electricity,  90 
of  exhaust  steam,  88 
of  gas,  91 
of  hot  air,  89 

water,  88 
of  open  fireplaces,  86 
of  petroleum,  91 
of  steam,  87 
of  stoves,  86 
combination  systems  of,  89 
direct,  83 
indirect,  83 
of  the  vessel,  307 
systems  of,  85 
Heredity,  22 

Hog-pens,  regulation  of,  455 
Holds,    disinfection    of,    419,   424,   425, 
435.  446 
of  iron  vessels,  424,  446 
of  wooden  vessels,  423,  446 
Hospitals,  disinfection  of,  428 
for  infectious  diseases,  480 
Hot  air,  heating  with,  89 
Hot-water  radiators,  87 
House,  foundation  of,  323  * 

position  of,  322 
quarantine,  395,  467 
roof  of,  323 
walls  of,  323 
House-cleaning,  330 
House-refuse,  regulation  of,  455 
House-yards,  regulation  of,  455 
Household  filters,  127 
Houses  for  the  poor,  328 
placarding  of,  465 
slaughter-,  regulation  of,  455 
Humidity  of  the  atmosphere,  37 
absolute,  37 
influence  on  health,  40 
relative,  40 
Hydrocyanic  acid,  379 
Hydrogen  sulphid,  56 
Hygiene,  28 
definition  of,  17 
development  of,  28 
industrial,  252 


49° 


INDEX. 


Hygiene,  military,  286 

naval,  304 

personal,  248 

school,  269 
Hygienic  conditions  of  environment,  25 
Hygrometer,  37 

Immediate  causes  of  disease,  17 
Immunity,  336 

prevention  of  infection  by,  351 
Improvement  of  a  damp  soil,  320 
Impure  air,  diseases  produced  by,  55 
Impurities  in  air,  49 
of  dwellings,  53 
of  factories,  53 
of  workshops,  53 
solid,   58 
source  of,  49 

due  to  combustion,  52 
to  perspiration,  52 
to  respiration,  49 
in  water,  96 
effects  of,  100 
gaseous,  100 
inorganic,  100 
organic,  102 
Indirect  radiation,  85,  89 
Industrial  establishments,  hygiene,  252 

lighting  of,  265 
Infancy,  diet  in,  229 
Infant  mortality,  rate  of,  475 
Infected  compartments,  disinfection  of, 
428 
ports,  regulations  at,  421 
vessels,  treatment  of,  423,  424,  439 
Infection  by  means  of  animal  parasites, 
prevention  of,  369 
prevention  of,  by  immunity,  351 
sources  of,  358,  359 
Infectious  diseases,  hospitals  for,  480 
interstate  notification  of,  459 
limitatiqn  of,  460 
Infective  materials,  disinfection  of,  383 
Influence  of  climate  on  health,  45 
mortality,  47 
of  excessive  amounts  of  food,  232 
of  humidity  on  health,  40 
of  insufficient  food,  231 
of  length  of  working-day,  264 
Information     for    masters     of    vessels, 

428 
Injurious  effects  of  clothing,  245 
Injury,  protection  against,  243 
Inland  quarantine,  394 
Inspection,  body,  303 
foot,  302 
meat,  196 

method  of,  197 
of  quarantines,  441 
local,  441 
State,  441 
of  schools,  medical,  281 
of  vessels,  411,  430 
card,  416 
Instruction  for  disinfection,  389 


Insufficient  food,  influence  of,  231 
Interior  arrangement  of  house,  324 
Intermittent  filtration,  116 
Interstate  notification  of  diseases,  459 

quarantine,  447 

general  regulations  of,  448 
Intestinal  diseases,  disinfection  in,  386 
Iron  in  water,  141 

sulphate  of,  382 

vessels,  disinfection  of,  424,  446 
Irrigation,  subsurface,  160 
Isolation,  395 

period  of,  399 

value  of,  395 

Jets,  76 

Laborers,  health  of,  264 
Lake-water,  95 

supplies,  109 
Lard,  adulteration  of,  226 
Latrines,  277,  298 
Laundry,  amount  of  water  required  for, 

106 
Laws,  quarantine,  401 
Lean  beef,  204 
Leather,  articles  of,  disinfection  of,  437, 

421 
Length   of  working-day,    influence   of, 

264 
Life,  expectation  of,  477 

mean  duration  of,  476 

probable  duration  of,  477 
Light  meat,  effect  of,  203 
Lighting,  273,  307 

of  industrial  establishments,  265 

of  the  vessel,  307 
Lime,  chlorinated,  381 

milk  of,  382 

preparations  of,  381 
Living  compartments  of  vessels,  425 
Local  quarantines,  inspection  of,  441 
Location  of  camps,  296 
Loss  of  heat  from  buildings,  82 
Lungs,  effect  of  exercise  on,  233 

Malaria,  prevention  of,  360 
Malt  liquors,  adulteration  of,  227 
Management  of  piggeries,  466 
Marches,  301 
Marines,  diseases  among,  315 

selection  of,  309 
Maritime  quarantine,  393,  400 
Masters  of  vessels,  information  for,  428 
Materials,  infective,  disinfection  of,  383 
Matter,  organic,  50 
Mean  age  at  death,  476 

duration  of  life,  476 
Means,  mechanical,  of  ventilation,  75 
Measures,  preventive,  358,  359 
Meat,  195 

effects  of  light  and  dark,  203 

inspection,  196 
method  of,  197 

preservation  of,  200 


INDEX. 


491 


Meat,  preservation  of,  detection  of  pre- 
servatives, 201 
putrefactive  changes  in,  200 
relative  composition  of,  205 
Mechanical  filter,  121 
filtration,  120 
means  of  ventilation,  75 
Medical  inspection  of  schools,  281 
Mental  attitude,  251 
Method  of  protection,  Haffkine,  356 
Methods  of  piping,  88 

of  sewage  purification,  157 
Garfield  coal  filters,  165 
sand  filters,  158 
septic  tank,  160 
subsurface  irrigation,  160 
of  ventilation,  63 

extraction  and  propulsion,  80 
natural  and  artificial,  81 
of  water  and  sewage  analysis,  133 
chemical  analysis,  136 
collection  of  samples,  133 
microscopic  examination,  136 
physical  examination,  135 
water  purification,  112 

mechanical  filtration,  120 
sand  filtration,  115 
self-purification,  112 
Mexican  frontiers,  441 
Microscopic  examination  of  water,  136 
Military  hygiene,  286 
Milk,  adulteration  of,  225 
and  milk  products,  205 
care  of,  215 

diseases  conveyed  by,  206 
influence  of  food-supply  on,  210 
municipal  control  of,  212 
of  lime,  382 
Milking,  214 
Mineral  food,  222 

particles  in  water,  100 
Minimum  standard  of  daily  diet,  186 
Modes  of  dissemination  of  disease,  334, 

358,  359 
Moist  heat,  382 
Moisture,  precipitation  of,  42 
Moral  training  of  the  recruit,  290 
Mortality,  comparative,  256,  257,  258 
infant,  rate  of,  475 
influence  of  climate  upon,  47 
in  relation  to  season,  476 
Mosquitoes,  Anopheles,  culex,  362 
destruction  of,  367 
protection  from,  331 
Mouth,  cleanliness  of,  249 
Movements  of  the  atmosphere,  41 
Muscles,  effect  of  exercise  on,  236 
Mustard,  adulteration  of,  227 
Mutton,  204 

Napkins,  disinfection  of,  389 
Natural  ventilation,  63 

arrangements  in,  65 

comparison  of,  81 
waters,  comparison  of,  95 


Nature  of  epidemics,  335 

of  the  atmosphere,  31 
Naval  hygiene,  304 

vessels,  regulations  relating  to,  443 
Necessity  of  system  of  notification,  479 
Nervous  system,  effect  of  exercise  on, 

237 
Night-soil  in  public  waters,  467 
Nitrate  of  silver,  381 
Nitrogen  as  free   and   albuminoid   am- 
monia, 139 

as  nitrates,  139 

as  nitrites,  139 

elimination,  effect  of  exercise  on,  237 
Non-alcoholic  beverages,  224 
Normal  feet,  244 

temperature  and  rainfall,  44 
Notification,  448 

interstate,  of  diseases,  459 

system  of,  479 
Noxious  trades,  455 
Nuisances,  abatement  of,  454 

definition  of,  455 

removal  of,  454 
Nutritive  value  and  cost  of  food,  188 

Occupation,  nature  of,  250 

Occupations,  death-rate  in,  475 

Officers'  quarters,  disinfection  of,  419 

Old  age,  diet  for,  231 

Open  fireplaces,  86 

Oporto,  quarantine  regulations  for,  423 

treatment  of  vessels  from,  423 
Organic  impurities  in  water,  102 

matter,  50 
Outer  garments,  292 
Oxidation,  112 
Oxygen  consumed,  140 

dissolved,  141 

Parasites,  animal  and  vegetable,  368 

prevention  of  infection  by,  369 
Particles,  mineral,  in  water,  100 
Passengers,  414 

detention  of,  437 

disinfection  of  personal  effects  of,  426, 
438 
Passions,  regulation  of,  249 
Pathogenic  bacteria  in  soil,  320 

persistence  of,  360 
Patients,  disinfection  of,  388 
Pennsylvania   State    Board   of    Health, 

regulations  of,  454 
Pepper,  adulteration  of,  227 
Period  of  detention,  399 

of  isolation,  399 
Persistence  of  bacteria  in  dead  bodies, 

360 
Personal    effects,    disinfection    of,    426, 
.438 

hygiene,  248 

prophylaxis,  357 
Personnel,  detention  of,  427,  445 
Perspiration,  impurities  due  to,  52,  56 
Petroleum,  heating  by  means  of,  91 


492 


INDEX. 


Physical  agents,  382 

examination  of  water,  135 

properties  of  water,  92 

training  of  the  recruit,  289 
Piggeries,  management  of,  466 
Piping,  methods  of,  88 

systems  of,  87 
Placarding  of  nouses,  465 
Plague-infected    vessels,    treatment    of, 

423,  443,  444,  446 
Plague,   prevention  of  introduction   of, 

423 
of  spread  of,  in  United  States,  452 
regulations  at  ports,  421 
Plant,  steam  disinfecting,  375 
Plumbing,  328 

Policing,  sanitary,  of  camps,  296 
Pollution  of  streams,  prevention  of,  466, 

467 
Pond-water  supplies,  109 
Poor,  houses  for  the,  328 
Population,  density  of,  relation  to  death- 
rate,  478 
Pork,  204 

Porto  Rico,  baggage  from,  422 
Ports,  domestic,  quarantine  regulations 
for,  423 
foreign,    quarantine    regulations    at, 

408 
infected  with  plague,  regulations  at, 

421 
of  the  United  States,  regulations  for, 
429 
Position  of  blackboards,  274 

of  the  house,  322 
Potential  energy  in  food,  180 
Poultry,  205 
Powders,  baking,  220 
Precipitation,  113 
mean  annual,  44 
of  moisture,  42 
Predisposing  causes  of  disease,  19 
Preliminary  disinfection,  424,  445 
Preparations  of  lime,  381 
Preservation  of  meat,  200 

detection  of,  201 
Preservatives,  food,  221 
Preserved  vegetable  foods,  222 
Pressure  of  the  atmosphere,  34 

distribution  of,  36 
Prevention  of  blindness,  464 

of  infection  by  animal  parasites,  369 
of  infection  by  immunity,  351 
of  introduction  of  plague,  423 
of  malaria,  360 
of  yellow  fever,  362 
Preventive  measures,  358,  359 
Probable  duration  of  life,  477 
Proper  soles,  244 

Properties,  chemical,  of  water,  92 
Prophylaxis,  personal,  357 
Propulsion  method  of  ventilation,  80 
Protection  against  cold,  241 
against  dampness,  242 
against  heat,  242 


Protection  against  injury,  243 
against  small-pox,  352 
from  flies  and  mosquitoes,  331 
Haff kine  method  of,  356 
Public  conveyances,  disinfection  of,  390 
waters,  dumping  of  night-soil  in,  467 
prevention  of  pollution  of,  466 
Pumps,  76 

Purification  of  sewage,  methods  of,  157 
Cameron  septic  tank,  160 
Garfield  coal  filters,  165 
sand  filters,  158 
subsurface  irrigation,  160 
of  water,  111 
methods  of,  112 
filtration,  115 
without  filtration,  128 
boiling,  128 
chemicals,  130 
distillation,  128 
sterilization,  129 
Purity,  standard  of,  60 
Putrefactive  changes  in  meat,  200 

Quantitative  bacterial  examination 

of  water,  142 
Quarantinable  diseases,  448 
Quarantine,  393,  432 
domiciliary,  464 

regulation  of,  464 
general  requirements  at,  434 
house,  395,  467 
inland,  394 
interstate,  447 

general  regulations,  448 
laws,  401 
local,  441 
maritime,  393,  400 
regulations  at  domestic  ports,  423 
at  foreign  ports,  408 
at  ports  of  the  United  States,  429 
at  sea,  417 
on  frontiers,  429 
State,  inspection  of,  441 

regulations,  453 
treatment  of  vessels  in,  423,  434 
Quarters,  officers',  disinfection  of,  419 

Race,  24 

Radiating  surfaces,  heat  supplied  by,  83 

Radiation,  direct,  85,  86 

heat  emitted  by,  84 

indirect,  85,  89 
Radiators,  steam,  86 

and  hot  water,  86 
Rainfall,  normal,  44 
Rain-water,  93 

supplies,  108 
Rats,  extermination  of,  367 
Records  of  inspections,  421 
Recruit,  the,  286 

training  of  the,  289 
moral,  290 
physical,  289 
Refuse  from  tanneries,  466 


INDEX. 


493 


Regulations     of     Pennsylvania     State 
Board  of  Health,  454 
quarantine,  453 

at  domestic  ports,  423 
at  foreign  ports,  408 
Relation  of  mortality  to  season,  476 
Relative  humidity,  40 
Remote  causes  of  disease,  18 
Removal  and  disposal  of  garbage,  174 
of  nuisances,  454 
of  sewage,  147 

Liernur  system,  170 
of  dust,  78 
Report,  clinical,  418 
Reports  of  inspections,  421 
Requirements,  sanitary,  with  regard  to 
vessels,  411 
in  quarantine,  434 
at  sea,  417 
Residue  on  evaporation,  138 
Respiration,  impurities  due  to,  49,  56 
Respiratory    diseases,    disinfection    in, 

385' 
Revised  statutes,  406 
Ridge  ventilation,  299 
River-water,  94 
Roof,  323 

Room,  disinfection  of,  389 
Rooms,  size  of,  324 

sleeping-,  325 
Rules,  fifty  dairy,  213 

general,  for  ventilation,  63 

Sand  filtration,  115 

intermittent,  116 
Sanitary  policing  of  camps,  296 
science,  27 

supervision  of  traffic,  457 
of  travel,  457 
Santos,  quarantine  regulations  for,  423 

treatment  of  vessels  from,  423 
Scarlet  fever,  isolation  and  disinfection 

in,  396 
School-buildings,  defects  in,  280 
School  hygiene,  269 
Schools,  closure  of,  464 

medical  inspection  of,  281 
Science,  sanitary,  27 
Sea,  quarantine  regulations  at,  408 

requirements  at,  417 
Sea-water,  95 
Season,  influence  upon  mortality,  47 

relation  of  mortality  to,  476 
Seats,  277 
Sedimentation,  112 
Selection  of  marines,  309 
Senses,  examination  of  air  by,  54 
Septic  tank,  160 

Sewage  analysis,  methods  of,  133 
chemical  analysis,  136 
collection  of  samples,  133 
microscopic  examination,  136 
physical  examination,  135 
quantitative  bacterial  examination, 
142 


Sewage,  chemical  treatment  of,  155 
commercial  value  of,  171 
from  tanneries,  466 
purification,  methods  of,  157 
Cameron  septic  tank,  160 
Garfield  coal  filters,  165 
sand  filters,  158 
subsurface  irrigation,  160 
removal  and  disposal,  147 
disposal,  147,  154,  277 
dry  method,  153 
removal,  147 

Liernur  system,  170 
Sewer-air,  48 
Sex,  22 

Shoemaker's  soles,  243,  244 
Sick-room,  disinfection  of,  384 
Silver,  nitrate  of,  381 
Site,  269 

Size  of  rooms,  324 
Slaughter-houses,  regulation  of,  455 
Sleeping-rooms,  315 
Small-pox,  disinfection  in,  451 

protection  against,  352 
Soda,  washing,  382 
Soil,  317 

covering,  320 

damp,  improvement  of,  320 
drainage  capacity  of,  269 
pathogenic  bacteria  in,  320 
pipe,  151 
Soldier,  clothing  of,  292 
Sole,  correct,  243,  244 

shoemaker's,  243,  244 
Solid  impurities  in  air,  effects  of,  58 

in  water,  100 
Solutions,  standard  disinfecting,  390 
Sources  of  impurities  in  air,  49 
of  infection,  358,  359 
of  water-supplies,  107 
ground-water,  109 
lake  and  pond,  109 
river,  108 
surface  water,  107 
Space,  cubic,  61,  270 
floor,  272 
window,  272 
Special    regulations   relating    to    naval 

vessels,  443 
Specifications  for  mechanical  filter,  122 
purification  required,  123 
regulation,  124 
tests,  124 
waste,  124 
Spring-water,  93 
Stable,  213 

Standard  disinfecting  solutions,  390 
of  age-distribution,  472 
of  purity,  60 
State  quarantines,  453 
inspection  of,  441 
regulations,  453 
State-rooms,  disinfection  of,  419 
Statistics,  vital,  470 
Statutes,  Revised,  406 


494 


INDEX. 


Steam  chamber,  use  of  formaldehyd  in 
426 
disinfecting  plant,  375 
heating  by,  87 
radiators,  86,  89 
Steerage,  disinfection  of,  419,  435 
Sterilizer,  water,  129,  130,  297 
Stock-yards,  regulation  of,  455 
Storage  of  water,  11 1 
Stoves,  86 

Streams,  pollution  of,  466,  467 
Streets,  regulation  of,  455 
Structure  of  walls,  270 
Sublimate,  corrosive,  381 
Subsistence  diet  for  adults,  229 
Subsurface  irrigation,  160 
Sulphate  of  iron,  382 
Sulphur  dioxid,  379 
Sulphuric  acid,  141 
Sunlight,  383 

Supplies,  water,  from  ground,  109 
from  lake,  109 
from  pond,  109 
from  rain,  93 
from  river,  108 
from  spring,  93,  no 
from  surface,  107 
from  well,  94,  no 
Surface,  configuration  of,  320 

water,  107 
Surfaces,  radiating,  83 
Susceptibility,  336 
System,  contact-bed,  164 
Liernur,  166 

nervous,  effect  of  exercise  on,  237 
Systems  of  heating,  85,  89 

of  notification,  necessity  for,  479 
of  piping,  87 

Tanneries,  refuse  from,  466 
Tea,  adulteration  of,  226 
Teeth,  cleanliness  of,  249 
Temperature  of  the  air,  33 
difference  in,  64 
normal,  44 
Tents,  295 

Trades,  noxious,  455 
Traffic,  sanitary  supervision  of,  457 
Training  of  the  recruit,  moral,  290 

physical,  289 
Transportation  of  dead  bodies,  458 
Traps,  150 

anti-D  trap,  151 
bell  trap,  150 
Mason's  trap,  151 
S-'rap,  150 
Travel,  sanitary  supervision  of,  457 
Treatment  of  infected  vessels,  423,  439 
in  cholera,  435 
in  plague,  423,  443 
in  yellow  fever,  439 
of  sewage,  chemical,  155 
Trikresol,  381 
Typhoid  fever,  102 
Typhus  fever,  disinfection  in,  452 


Underclothing,  292 

United  States  ports,  quarantine  regula- 
tions for,  429 

Upholstered  furniture,  shipment  of,  414, 
437 

Utensils,  milk,  216 

Vaccinated  persons,  quarantine  reg- 
ulations for,  416 
Vaccination  as  protective  against  small- 
pox, 352 
Value  of  isolation  and  disinfection,  395 

of  sewage,  commercial,  171 
Vapor,  aqueous,  50 

elastic  force  of,  39 
Veal,  204 
Vegetable  foods,  218 

canned,  adulteration  of,  226 
preserved,  221 

parasites,  368 
Ventilation,  59,  275,  305,  327 

artificial,  74 

comparison  of  methods,  81 

extraction-methods,  81 

general  rules  for,  63 

natural,  63 

arrangements  in,  65 

propulsion  methods,  81 

ridge,  299 
Vessel,  cleaning  of,  307 

heating  of,  307 

lighting  of,  307 
Vessels,  cholera-infected,  treatment  of, 

.  .  434 
disinfection  of,  419 

cabin,  419,  437 

cargo,  419,  424,  438 

forecastle,  419,  436 

holds,  419,  424,  425,  435,  446 

hospitals,  428 

iron,  424,  446 

living  compartments,  425 

officers'  quarters,  419 

state-rooms,  419 

steerage,  419,  435 

water-closets,  429 

wooden,  425,  446 
final  disposition  of,  427 
inspection  of,  423 
masters  of,  information  for,  428 
naval,  special  regulations  for,  443 
plague-infected,     treatment    of,    423, 

443.  444 
requirements  with  regard  to,  411 
treatment  of,  from  Oporto,  423 
from  Santos,  423 
in  quarantine,  423,  434 
yellow-fever    infected,    treatment    of, 

419.  439 

Vinegar,  adulteration  of,  227 

Vital  causes  of  disease,  332 
statistics,  470 

Vitiated  air,  effects  of,  58 

Vitiation  by  respiration  and  perspira- 
tion, 56 


INDEX. 


495 


WALL-covering,  326 
"Walls  of  house,  323 

structure  of,  270 
Wardrobes,  274 
Warmth,  degree  of,  82 
Washing  soda,  382 
Water  analysis,  method  of,  133 
chemical,  136 
alkalinity,  140 
carbonic  acid,  141 
chlorin,  138 
hardness,  140 
iron,  141 

nitrogen  as  ammonia,  139 
as  nitrates,  139 
as  nitrites,  139 
oxygen  consumed,  140 
residue  on  evaporation,  138 
sulphuric  acid,  141 
collection  of  samples,  133 
microscopic,  136 
physical,  135 

quantitative  bacterial,  142 
and  water-supply,  92,  277,  296,  308 

amount  required,  106 
as  food,  194 

chemical  composition  of,  92 
ground-,  95,  109,  318 
impurities  in,  96 
effects  of,  100 
gaseous,  100 
inorganic,  100 
organic,  102 
solid,  100 
lake-,  95 

physical  properties  of,  92 
pond-,  109 
rain-,  93 
river-,  94 
sea-,  95 
spring-,  93 

suitability  for  boiler  purposes,  132 
well-,  94 


Water,  pollution  of,  466,  467 
purification  of,  in 
methods  of,  112,  144 
filtration,  115 
self-purification,  112 
without  filtration,  128 
by  boiling,  128 
by  chemicals,  130 
by    distillation,  128 
by  sterilization,  128 
storage  of,  111 
sterilizer,  129,  297 
waste-preventer,  149 
Water-closet,  277,  147 

amount  of  water  required  for,  106 
disinfection  of,  429 
hopper,  148 
pan, 148 
wash-down,  149 
wash-out,  149 
Water-supplies,  sources  of,  107 
ground-water,  109 
lakes  and  ponds,  109 
rivers,  108 
surface  water,  107 
Waters,  natural,  comparison  of,  95 
Well-water,  94 
Wells,  artesian,  no 
Wind,  action  of,  64 

effects  upon  health,  41 
Window  space,  272 
Wooden    vessels,    disinfection   of,    425, 

446 
Working-day,  influence  of  length  of,  564 
Work-rooms,  air  of,  53 

Yards,  house,  regulation  of,  455 

stock-,  regulation  of,  455 
Yellow  fever,  disinfection  in,  451 
of  vessels  in,  419 
prevention  of,  362 
quarantine  regulations,  449 
treatment  of  vessels  in,  419,  439 


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Haynes'  Anatomy. 

A  Manual  of  Anatomy.  By  Irving  S.  Haynes,  M.  D.,  Professor  of 
Practical  Anatomy  in  Cornell  University  Medical  College.  680  pages ; 
42  diagrams  and  134  full-page  half-tone  illustrations  from  original  photo- 
graphs of  the  author's  dissections.     Cloth,  £2.50  net. 

Heisler'S    Embryology.       Second  Edition,  Revised, 

A  Text-Book  of  Embryology.  By  John  C.  Heisler,  M.  D.,  Professor 
of  Anatomy,  Medico-Chirurgical  College,  Philadelphia.  Octavo  volume 
of  405  pages,  handsomely  illustrated.     Cloth,  $2.50  net. 

Hirst'S    Obstetrics.       Third  Edition,  Revised  and  Enlarged. 

A  Text-Book  of  Obstetrics.     By  Barton  Cooke  Hirst,  M.  D.,  Professor 
of  Obstetrics,    University  of  Pennsylvania.      Handsome  octavo  volume - 
of  873  pages;  704  illustrations,  36  of  them  in  colors.     Cloth,  $5.00  net; 
Sheep  or  Half  Morocco,  $6.00  net. 


MEDICAL   PUB LIC A  TIONS 


Hyde  and  Montgomery  on   Syphilis  and  the  Venereal 

Diseases.       Second  Edition,  Revised  and  Greatly  Enlarged. 

Syphilis  and  the  Venereal  Diseases.  By  James  Kevins  Hyde,  M.  D., 
Professor  of  Skin  and  Venereal  Diseases,  and  Frank  H.  Montgomery, 
M.  D.,  Associate  Professor  of  Skin,  Genito-Urinary,  and  Venereal  Dis- 
eases in  Rush  Medical  College,  Chicago,  111.  Octavo,  594  pages, 
profusely  illustrated.     Cloth,  $4.00  net. 

<n?e  International  Text- Book  of  Surgery.    in  Two  volumes. 

By  American  and  British  Authors.  Edited  by  T-  Collins  Warren, 
M.  D.,  LL.  D.,  F.  R.  C.  S.  (Hon.),  Professor  of  Surgery,  Harvard  Medi- 
cal School,  Boston ;  and  A.  Pearce  Gould,  M.  S.,  F.  R.  C.  S.,  Lecturer 
on  Practical  Surgery  and  Teacher  of  Operative  Surgery,  Middlesex 
Hospital  Medical  School,  London,  Eng.  Vol.  I.  General  Surgerx. — 
Handsome  octavo,  947  pages,  with  458  beautiful  illustrations  and  9 
lithographic  plates.  Vol.  II.  Special  or  Regional  Surgery. — Handsome 
octavo,  1072  pages,  with  471  beautiful  illustrations  and  8  lithographic 
plates.  Sold  by  Subscription.  Prices  per  volume:  Cloth,  $5.00  net; 
Sheep  or  Half  Morocco,  $6.00  net. 

"  It  is  the  most  valuable  work  on  the  subject  that  has  appeared  in  some  years.  The  clini- 
cian and  the  pathologist  have  joined  hands  in  its  production,  and  the  result  must  be  a  satis- 
faction to  the  editors  as  it  is  a  gratification  to  the   conscientious  reader." — An>ials  of  Surgery. 

"  This  is  a  work  which  comes  to  us  on  its  own  intrinsic  merits.  Of  the  latter  it  has  very- 
many.  The  arrangement  of  subjects  is  excellent,  and  their  treatment  by  the  different  authors 
is  equally  so.  What  is  especially  to  be  recommended  is  the  painstaking  endeavor  of  each 
writer  to  make  his  subject  clear  and  to  the  point.  To  this  end  particularly  is  the  technique 
of  operations  lucidly  described  in  all  necessary  detail.  And  withal  the  work  is  up  to  date  in 
a  very  remarkable  degree,  many  of  the  latest  operations  in  the  different  regional  parts  of  the 
body  being  given  in  full  details.  There  is  not  a  chapter  in  the  work  from  which  the  reader 
may  not  learn  something  new." — Medical  Record,  New  York. 

Jackson's  Diseases  of  the  Eye. 

A  Manual  of  Diseases  of  the  Eye.  By  Edward  Jackson,  A.  M.,  M.  D., 
Emeritus  Professor  of  Diseases  of  the  Eye,  Philadelphia  Polyclinic  and 
College  for  Graduates  in  Medicine.  121110  volume  of  535  pages,  with 
178  illustrations,  mostly  from  drawings  by  the  author.    Cloth,  $2.50  net. 

Keating's  Life  Insurance. 

How  to  Examine  for  Life  Insurance.  By  John  M.  Keating,  M.  D., 
Fellow  of  the  College  of  Physicians  of  Philadelphia ;  Ex-President  of  the 
Association  of  Life  Insurance  Medical  Directors.  Royal  octavo,  211 
pages.     With  numerous  illustrations.     Cloth,  $2.00  net. 

Keen  on  the  Surgery  of  Typhoid  Fever. 

The  Surgical  Complications  and  Sequels  of  Typhoid  Fever.  By  Wm. 
W.  Keen,  M.  D.,  LL.  D.,  F.  R.  C.  S.  (Hon.),  Professor  of  the  Principles 
of  Surgery  and  of  Clinical  Surgery,  Jefferson  Medical  College,  Phila- 
delphia, etc.    Octavo  volume  of  386  pages,  illustrated.    Cloth,  $3.00  net. 

Keen's    Operation    Blank.       Second  Edition.  Revised  Form. 

An  Operation  Blank,  with  Lists  of  Instruments,  etc.,  Required  in  Vari- 
ous Operations.  Prepared  by  W.  W.  Keen,  M.  D.,  LL.  D.,  F.  R.  C.  S. 
(Hon.),  Professor  of  the  Principles  of  Surgery  and  of  Clinical  Surgery, 
Jefferson  Medical  College,  Philadelphia.  Price  per  pad,  blanks  for  fifty 
operations,  50  cts.  net. 


OF    W.  B.  SAUNDERS   &    CO. 


Kyle  on  the  Nose  and  Throat,    second  Edition. 

Diseases  of  the  Nose  and  Throat.  By  D.  Braden  Kyle,  M.  D.,  Clinical 
Professor  of  Laryngology  and  Rhinology,  Jefferson  Medical  College, 
Philadelphia.  Octavo,  646  pages;  over  150  illustrations  and  6  litho- 
graphic plates.     Cloth,  $4.00  net;  Sheep  or  Half  Morocco,  $5.00  net. 

Laine's  Temperature  Chart. 

Temperature  Chart.  Prepared  by  D.  T.  Laixe,  M.  D.  Size  8x13^ 
inches.  A  conveniently  arranged  Chart  for  recording  Temperature, 
with  columns  for  daily  amounts  of  Urinary  and  Fecal  Excretions,  Food, 
Remarks,  etc.  On  the  back  of  each  chart  is  given  the  Brand  treatment 
of  Typhoid  Fever.     Price,  per  pad  of  25  charts,  50  cts.  net. 

Levy,  Klemperer,  and  Eshner's  Clinical  Bacteriology. 

The  Elements  of  Clinical  Bacteriology.  By  Dr.  Ernst  Levy,  Pro- 
fessor in  the  University  of  Strasburg,  and  Felix  Klemperer,  Privat- 
docent  in  the  University  of  Strasburg.  Translated  and  edited  by 
Augustus  A.  Eshner,  M.  D.,  Professor  of  Clinical  Medicine,  Philadel- 
phia Polyclinic.     Octavo,  440  pages,  fully  illustrated.     Cloth,  $2.50  net. 

Lockwood's  Practice  tf  Medicine.         R.?eeT^dCSSed. 

A  Manual  of  the  Practice  of  Medicine.  By  George  Roe  Lockwood, 
M.  D.,  Professor  of  Practice  in  the  Woman's  Medical  College  of  the 
New  York  Infirmary,  etc. 

Long's  Syllabus  of  Gynecology. 

A  Syllabus  of  Gynecology,  arranged  in  Conformity  with  "An  American 
Text-Book  of  Gynecology."  By  J.  W.  Loxg,  M.  D.,  Professor  of  Dis- 
eases of  Women  and  Children,  Medical  College  of  Virginia,  etc.  Cloth, 
interleaved,  $1.00  net. 

Macdonald's  Surgical  Diagnosis  and  Treatment. 

Surgical  Diagnosis  and  Treatment.  By  J.  W.  Macdoxald,  M.  D. 
Edin.,  F.  R.  C.  S.  Edin.,  Professor  of  Practice  of  Surgery  and  Clinical 
Surgery,  Hamline  University.  Handsome  octavo,  800  pages,  fully  illus- 
trated.    Cloth,  $5.00  net;  Sheep  or  Half  Morocco,  $6.00  net. 

Mallory  and  Wright's  Pathological  Technique. 

Second  Edition,  Revised. 

Pathological  Technique.  A  Practical  Manual  for  Laboratory  Work  in 
Pathology,  Bacteriology,  and  Morbid  Anatomy,  with  chapters  on  Post- 
Mortem  Technique  and  the  Performance  of  Autopsies.  By  Fraxk  B. 
Mallory,  A.  M.,  M.  D.,  Assistant  Professor  of  Pathology,  Harvard 
University  Medical  School,  Boston;  and  James  H.  Wright,  A.M., 
M.  D.,  Instructor  in  Pathology,  Harvard  University  Medical  School, 
Boston. 

McFarland's  Pathogenic  Bacteria.  ™  %*%%''%?£&.  in 

Text-Book  upon  the  Pathogenic  Bacteria.  By  Joseph  McFarlaxd, 
M.  D.,  Professor  of  Pathology  and  Bacteriology,  Medico-Chirurgical 
College  of  Philadelphia,  etc.  Octavo  volume  of  621  pages,  finely  illus- 
trated.    Cloth,  $3.25  net. 


MEDIC  A I   PUB  IIC A  TIONS 


Meigs  on  Feeding  in  Infancy. 

Feeding  in  Early  Infancy.  By  Arthur  V.  Meigs,  M.  D.  Bound  in 
limp  cloth,  flush  edges,  25  cts.  net. 

Moore's  Orthopedic  Surgery. 

A  Manual  of  Orthopedic  Surgery.  By  James  E.  Moore,  M.  D.,  Pro- 
fessor of  Orthopedics  and  Adjunct  Professor  of  Clinical  Surgery,  Uni- 
versity of  Minnesota,  College  of  Medicine  and  Surgery.  Octavo  volume 
of  356  pages,  handsomely  illustrated.     Cloth,  §2.50  net. 

Morten's  Nurses'  Dictionary. 

Nurses'  Dictionary  of  Medical  Terms  and  Nursing  Treatment.  Con- 
taining Definitions  of  the  Principal  Medical  and  Nursing  Terms  and 
Abbreviations ;  of  the  Instruments,  Drugs,  Diseases,  Accidents,  Treat- 
ments, Operations,  Foods,  Appliances,  etc.  encountered  in  the  ward  or 
in  the  sick-room.  By  Honnor  Morten,  author  of  "How  to  Become 
a  Nurse,"  etc.      161110,  140  pages.     Cloth,  $1.00  net. 

Nancrede's  Anatomy  and  Dissection.    Fourth  Edition. 

Essentials  of  Anatomy  and  Manual  of  Practical  Dissection.  By  Charles 
B.  Nancrede,  M.  D.,  LL.  D.,  Professor  of  Surgery-  and  of  Clinical  Sur- 
gery, University  of  Michigan,  Ann  Arbor.  Post-octavo,  500  pages,  with 
full-page  lithographic  plates  in  colors  and  nearly  200  illustrations.  Extra 
Cloth  (or  Oilcloth  for  dissection-room),  52.00  net. 

Nancrede's  Principles  of   Surgery. 

Lectures  on  the  Principles  of  Surgery.  By  Chas.  B.  Nancrede,  M.  D.,. 
LL.  D.,  Professor  of  Surgery  and  of  Clinical  Surgery,  University  of 
Michigan,  Ann  Arbor.    Octavo,  398  pages,  illustrated.    Cloth,  $2.50  net. 

Norris's  Syllabus  of  Obstetrics.    Third  Edition,  Revised. 

Syllabus  of  Obstetrical  Lectures  in  the  Medical  Department  of  the 
University  of  Pennsylvania.  By  Richard  C.  Norris,  A.  M.,  M.  D., 
Instructor  in  Obstetrics  and  Lecturer  on  Clinical  and  Operative  Obstet- 
rics, University  of  Pennsylvania.  Crown  octavo,  222  pages.  Cloth, 
interleaved  for  notes,  S2.00  net. 

Ogden  on  the  Urine. 

Clinical  Examination  of  the  Urine  and  Urinary  Diagnosis.  A  Clinical 
Guide  for  the  Use  of  Practitioners  and  Students  of  Medicine  and  Sur- 
gery. By  J.  Bergen  Ogden,  M.  D.,  Instructor  in  Chemistry,  Harvard 
Medical  School.  Handsome  octavo,  416  pages,  with  54  illustrations 
and  a  number  of  colored  plates.     Cloth,  $3.00  net. 

Penrose's  Diseases  of  Women.    Fourth  Edition,  Revised. 

A  Text-Book  of  Diseases  of  Women.  By  Charles  B.  Penrose,  M.  D., 
Ph.  D.,  formerly  Professor  of  Gynecology  in  the  University  of  Penn- 
sylvania. Octavo  volume  of  538  pages,  handsomely  illustrated.  Cloth, 
#3-75  net- 


OF    W.  B.  SAUNDERS   &    CO. 


Pryor — Pelvic  Inflammations. 

The  Treatment  of  Pelvic  Inflammations  through  the  Vagina.  By  W. 
R.  Pryor,  M.  D.,  Professor  of  Gynecology,  New  York  Polyclinic. 
i2mo,  248  pages,  handsomely  illustrated.     Cloth,  $2.00  net. 

Pye's  Bandaging. 

Elementary  Bandaging  and  Surgical  Dressing.  With  Directions  con- 
cerning the  Immediate  Treatment  of  Cases  of  Emergency.  By  Walter 
Pye,  F.  R.  C.  S.,  late  Surgeon  to  St.  Mary's  Hospital,  London.  Small 
i2mo,  over  80  illustrations.     Cloth,  flexible  covers,  75  cts.  net. 

Pyle's  Personal  Hygiene. 

A  Manual  of  Personal  Hygiene.  Proper  Living  upon  a  Physiologic 
Basis.  Edited  by  Walter  L.  Pyle,  M.  D.,  Assistant  Surgeon  to  the 
Wills  Eye  Hospital,  Philadelphia.  Octavo  volume  of  344  pages,  fully 
illustrated.      Cloth,  $1.50  net. 

Raymond's  Physiology.    RevUJt£ £S5Eta** 

A  Text-Book  of  Physiology.  By  Joseph  H.  Raymond,  A.  M.,  M.  D., 
Professor  of  Physiology  and  Hygiene  and  Lecturer  on  Gynecology  in 
the  Long  Island  College  Hospital. 

Salinger  and  Kalteyer's  Modern  Medicine. 

Modern  Medicine.  By  Julius  L.  Salinger,  M.  D.,  Demonstrator  of 
Clinical  Medicine,  Jefferson  Medical  College ;  and  F.  J.  Kalteyer, 
M.  D.,  Assistant  Demonstrator  of  Clinical  Medicine,  Jefferson  Medical 
College.     Handsome  octavo,  801  pages,  illustrated.     Cloth,  $4.00  net. 

Saundby's  Renal  and  Urinary  Diseases. 

Lectures  on  Renal  and  Urinary  Diseases.  By  Robert  Saundby,  M.  D. 
Edin.,  Fellow  of  the  Royal  College  of  Physicians,  London,  and  of  the 
Royal  Medico-Chirurgical  Society ;  Professor  of  Medicine  in  Mason 
College,  Birmingham,  etc.  Octavo,  434  pages,  with  numerous  illustra- 
tions and  4  colored  plates.     Cloth,  $2.50  net. 

Saunders'  Medical  Hand-Atlases. 

See  pages  16  and  17. 

Saunders*  Pocket  Medical  Formulary,  sixth  Edition,  Revised. 

By  William  M.  Powell,  M.  D.,  author  of  "Essentials  of  Diseases  of 
Children":  Member  of  Philadelphia  Pathological  Society.  Contain- 
ing 1844  formulae  from  the  best-known  authorities.  With  an  Appendix 
containing  Posological  Table,  Formulas  and  Doses  for  Hypodermic 
Medication,  Poisons  and  their  Antidotes,  Diameters  of  the  Female  Pelvis 
and  Fetal  Head,  Obstetrical  Table,  Diet  List  for  Various  Diseases,  Mate- 
rials and  Drugs  used  in  Antiseptic  Surgery,  Treatment  of  Asphyxia  from 
Drowning,  Surgical  Remembrancer,  Tables  of  Incompatibles,  Eruptive 
Fevers,  etc.,  etc.  Handsomely  bound  in  flexible  morocco,  with  side 
index,  wallet,  and  flap.     $2.00  net. 

Saunders*  Question-Compends, 

See  page  15. 


MEDICAL    PUBLICATIONS 


Scildder's    Fractures.       Second  Edition,  Revised. 

The  Treatment  of  Fractures.  By  Chas.  L.  Scudder,  M.  D.,  Assistant 
in  Clinical  and  Operative  Surgery,  Harvard  University  Medical  School. 
Octavo,  460  pages,  with  nearly  600  original  illustrations.  Polished 
Buckram,  54.50  net;    Half  Morocco,  $5.50  net. 

Senn's  Genito-Urinary  Tuberculosis. 

Tuberculosis  of  the  Genito-Urinary  Organs,  Male  and  Female.  By 
Nicholas  Senn,  M.  D.,  Ph.  D.,  LL.  D.,  Professor  of  the  Practice  of 
Surgery  and  of  Clinical  Surgery,  Rush  Medical  College,  Chicago. 
Handsome  octavo  volume  of  320  pages,  illustrated.     Cloth,  $3.00  net. 

Senn's  Practical  Surgery. 

Practical  Surgery.  By  Nicholas  Senn,  M.  D.,  Ph.  D.,  LL.  D.,  Pro- 
fessor of  the  Practice  of  Surgery  and  of  Clinical  Surgery,  Rush  Medical 
College,  Chicago.  Handsome  octavo  volume  of  1200  pages,  profusely 
illustrated.  Cloth,  $6.00  net;  Sheep  or  Half  Morocco,  $7.00  net. 
By  Subscription. 

Senn's  Syllabus  qf  Surgery. 

A  Syllabus  of  Lectures  on  the  Practice  of  Surgery,  arranged  in  con- 
formity with  "An  American  Text-Book  of  Surgery."  By  Nicholas 
Senn,  M.  D.,  Ph.  D.,  LL.  D.,  Professor  of  the  Practice  of  Surgery  and 
of  Clinical  Surgery,  Rush  Medical  College,  Chicago.     Cloth,  $1.50  net. 

Senn's    TumOrS.       Second  Edition,  Revised. 

Pathology  and  Surgical  Treatment  of  Tumors.  By  Nicholas  Senn,  M.  D. , 
Ph.  D.,  LL.  D.,  Professor  of  the  Practice  of  Surgery  and  of  Clinical 
Surgery,  Rush  Medical  College,  Chicago.  Octavo  volume  of  718  pages, 
with  478  illustrations,  including  12  full-page  plates  in  colors.  Cloth, 
$5.00  net;  Sheep  or  Half  Morocco,  $6.00  net. 

Starr's  Diets  for  Infants  and  Children. 

Diets  for  Infants  and  Children  in  Health  and  in  Disease.  By  Louis 
Starr,  M.  D.,  Editor  of  "An  American  Text-Book  of  the  Diseases  of 
Children."  230  blanks  (pocket-book  size),  perforated  and  neatly  bound 
in  flexible  morocco.     $1.25  net. 

Stengel's    Pathology.       Third  Edition,  Thoroughly  Revised. 

A  Text-Book  of  Pathology.  By  Alfred  Stengel,  M.  D.,  Professor  of 
Clinical  Medicine,  University  of  Pennsylvania;  Visiting  Physician  to 
the  Pennsylvania  Hospital.  Handsome  octavo,  873  pages,  nearly  400 
illustrations,  many  of  them  in  colors.  Cloth,  $5.00  net ;  Sheep  or  Half 
Morocco,  $6. 00  net. 

Stengel  arid  White  on  the  Blood. 

'  The  Blood  in  its  Clinical  and  Pathological  Relations.  By  Alfred 
Stengel,  M.  D.,  Professor  of  Clinical  Medicine,  University  of  Penn- 
sylvania; and  C.  Y.  White,  Jr.,  M.  D.,  Instructor  in  Clinical  Medicine, 
University  of  Pennsylvania.      ///  Press. 


OF   W.  B.  SAUNDERS   &>    CO. 


*3 


Stevens'  Therapeutics.      Third  Edition,  Revised  and  Greatly  Enlarged. 

A  Text-Book  of  Modern  Therapeutics.  By  A.  A.  Stevens,  A.  M. ,  M.  D., 
Lecturer  on  Physical  Diagnosis  in  the  University  of  Pennsylvania. 

Stevens'  Practice  of  Medicine.     Fifth  Edition,  Revised. 

A  Manual  of  the  Practice  of  Medicine.  By  A.  A.  Stevens,  A.  M., 
M.  D.,  Lecturer  on  Physical  Diagnosis  in  the  University  of  Pennsyl- 
vania. Specially  intended  for  students  preparing  for  graduation  and 
hospital  examinations.  Post-octavo,  519  pages;  illustrated.  Flexible 
Leather,  32.00  net. 

Stewart's    Physiology.       Fourth  Edition,  Revised. 

A  Manual  of  Physiology,  with  Practical  Exercises.  For  Students  and 
Practitioners.  By  G.  N.  Stewart,  M.  A.,  M.  D.,  D.  Sc,  Professor  of 
Physiology  in  the  Western  Reserve  University,  Cleveland,  Ohio.  Octavo 
volume  of  894  pages ;   336  illustrations  and  5  colored  plates.     Cloth, 

$3-75  net-   • 

Stoney's  Materia  Medica  for  Nurses. 

Materia  Medica  for  Nurses.  By  Emily  A.  M.  Stoxey,  late  Superintend- 
ent of  the  Training-School  for  Xurses,  Carney  Hospital,  South  Boston, 
Mass.     Handsome  octavo  volume  of  306  pages.     Cloth,  51.50  net. 

StOney's    Nursing.       Second  Edition,  Revised. 

Practical  Points  in  Nursing.  For  Nurses  in  Private  Practice.  By  Emily 
A.  M.  Stoxey,  late  Superintendent  of  the  Training-School  for  Nurses, 
Carney  Hospital,  South  Boston,  Mass.  456  pages,  with  73  engravings 
and  8  colored  and  half-tone  plates.      Cloth,  £1.75  net. 

Stoney's  Surgical  Technic  for  Nurses. 

Bacteriology  and  Surgical  Technic  for  Nurses.  By  Emily  A.  M.  Stoney, 
late  Superintendent  of  the  Training-School  for  Nurses,  Carney  Hospital, 
South  Boston,  Mass.     121110  volume,  fully  illustrated.     Cloth,  $1.25  net. 

Thomas's    Diet    ListS.       Second  Edition,  Revised. 

Diet  Lists  and  Sick-Room  Dietary.  By  Jerome  B.  Thomas,  M.  D., 
Visiting  Physician  to  the  Home  for  Friendless  AVomen  and  Children 
and  to  the  Newsboys'  Home ;  Assistant  Visiting  Physician  to  the  Kings 
County  Hospital.     Cloth,  Si. 25  net.     Send  for  sample  sheet. 

Thornton's  Dose-Book  arid  Prescription-Writing. 

Second  Edition,  Revised  and  Enlarged. 

Dose-Book  and  Manual  of  Prescription- Writing.  By  E.  Q.  Thorxtox, 
M.  D.,  Demonstrator  of  Therapeutics,  Jefferson  Medical  College,  Phila- 
delphia. 

Van  Valzah  arid  Nisbet's  Diseases  of  the  Stomach. 

Diseases  of  the  Stomach.  By  William  W.  Van  Valzah,  M.  D.,  Pro- 
fessor of  General  Medicine  and  Diseases  of  the  Digestive  System  and 
the  Blood,  New  Vork  Polyclinic ;  and  J.  Douglas  Nisbet,  M.  D., 
Adjunct  Professor  of  General  Medicine  and  Diseases  of  the  Digestive 
System  and  the  Blood,  New  York  Polyclinic.  Octavo  volume  of  674 
pages,  illustrated.     Cloth,  $3.50  net. 


1 4  MEDICAL   PUBLICATIONS. 

Vecki'S    SeXUal    Impotence.        Second  Edition,  Revised. 

The  Pathology  and  Treatment  of  Sexual  Impotence.  By  Victor  G. 
Vecki,  M.  D.  From  the  second  German  edition,  revised  and  enlarged. 
Demi-octavo,  291  pages.     Cloth,  $2.00  net. 

Vierordt'S    Medical     Diagnosis.       Fourth  Edition,  Revised. 

Medical  Diagnosis.  By  Dr.  Oswald  Vierordt,  Professor  of  Medicine, 
University  of  Heidelberg.  Translated,  with  additions,  from  the  fifth 
enlarged  German  edition,  with  the. author's  permission,  by  Francis  H. 
Stuart,  A.M.,  M.  D.  Handsome  octavo  volume,  603  pages;  194 
wood-cuts,  many  of  them  in  colors.  Cloth,  $4.00  net;  Sheep  or  Half 
Morocco,  $5.00  net. 

Watson's  Handbook  for  Nurses. 

A  Handbook  for  Nurses.  By  J.  K.  Watson,  M.  D.  Edin.  American 
Edition,  under  supervision  of  A.  A.  Stevens,  A.  M.,  M.  D.,  Lecturer 
on  Physical  Diagnosis,  University  of  Pennsylvania.  121110,  413  pages, 
73  illustrations.      Cloth,  $1.50  net. 

Warren's  Surgical  Pathology,     second  Edition. 

Surgical  Pathologv  and  Therapeutics.  By  John  Collins  Warren, 
M.  D.,  LL.  D.,  F.  R.  C.  S.  (Hon.),  Professor  of  Surgery,  Harvard 
■  Medical  School.  Handsome  octavo,  873  pages;  136  relief  and  litho- 
graphic illustrations,  33  in  colors.  With  an  Appendix  on  Scientific 
Aids  to  Surgical  Diagnosis,  and  a  series  of  articles  on  Regional  Bacte- 
riology.    Cloth,  $5.00  net;    Sheep  or  Half  Morocco,  $6.00  net. 


SAUNDERS' 
QUESTION -COM  PENDS. 

ARRANGED  IN  QUESTION  AND  ANSWER  FORM. 


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NOW    THE    STANDARD    AUTHORITIES    IN    MEDICAL    LITERATURE 

WITH 

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Since  the  issue  of  the  first  volume  of  the  Saunders  Question-Compends, 

OVER  200,000  COPIES 

of  these    unrivalled    publications    have    been   sold.      This    enormous    sale    is    indisputable 
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:  Where  the  work  of  preparing  students'  manuals  is  to  end  we  cannot  say,  but  the  Saunders  Series, 
in  our  opinion,  bears  off  the  palm  at  present." — New  York  Medical  Record. 


1.  Essentials  of  Physiology.     By  Sidney  Budgett,  M.D.     A  ATew  Work. 

2.  Essentials  of  Surgery.     By  Edward  Martin,  M.  D.     Seventh  edition,  revised,  with 

an  Appendix  and  a  chapter  on  Appendicitis. 

3.  Essentials  of  Anatomy.     By  Charles   B.   Nancrede,   M.  D.     Sixth  edition,  thor- 

oughly revised  and  enlarged. 

4.  Essentials  of  Medical  Chemistry,  Organic  and  Inorganic.     By  Lawrence  Wolff, 

M.  D.      Fifth  edition,  revised. 

5.  Essentials  of  Obstetrics.     By  W.  Easterly  Ashton,  M.D.    Fourth  edition,  revised 

and  enlarged. 

6.  Essentials  of  Pathology  and  Morbid  Anatomy.     By  F.  J.  Kalteyer,  M.  D.     In 

preparation. 

7.  Essentials  of  Materia  Medica,  Therapeutics,  and  Prescription-Writing.    By  Henry 

Morris,  M.  D.     Fifth  edition,  revised. 

8.  9.    Essentials  of  Practice  of  Medicine.     By  Henry  Morris,  M.  D.     An  Appendix 

on  Urine  Examination.  By  Lawrence  Wolff,  M.  D.  Third  edition,  enlarged 
by  some  300  Essential  Formulae,  selected  from  eminent  authorities,  by  Wm.  M. 
Powell,  M.  D.     (Double  number,  $1.50  net.) 

10.  Essentials  of  Gynecology.     By  Edwin  B.  Cragin,  M.  D.     Fifth  edition,  revised. 

11.  Essentials  of  Diseases  of  the  Skin.     By  Henry  W.  Stelwagon,  M.  D.     Fourth 

edition,  revised  and  enlarged. 

12.  Essentials  of  Minor  Surgery,  Bandaging,  and  Venereal   Diseases.     By  Edward 

Martin,  M.  D.     Second  edition,  revised  and  enlarged. 

13.  Essentials    of    Legal    Medicine,    Toxicology,    and    Hygiene.     This   volume    is    at 

present  out  of  print. 

14.  Essentials  of  Diseases  of  the  Eye.     By  Edward  Jackson,  M.  D.     Third  edition, 

revised  and  enlarged. 

15.  Essentials  of  Diseases  of  Children.    By  William  M.  Powell,  M.  D.    Third  edition. 

16.  Essentials   of    Examination    of    Urine.     By    Lawrence   Wolff,   M.  D.      Colored 

"  Vogel  Scale."     (75  cents  net.) 

17.  Essentials  of  Diagnosis.     By  S.   Solis-Cohen,   M.  D.,   and   A.    A.  Eshner,  M.D. 

Second  edition,  thoroughly  revised. 

18.  Essentials    of    Practice    of    Pharmacy.     By  Lucius    E.    Sayre.     Second  #  edition, 

revised  and  enlarged. 

19.  Essentials  of  Diseases  of  the  Nose  and  Throat.     By  E.  B.  Gleason,  M.  D.     Third 

edition,  revised  and  enlarged. 

20.  Essentials  of  Bacteriology.     By  M.-V.  Ball,  M.  D.     Fourth  edition,  revised. 

21.  Essentials  of  Nervous  Diseases  and  Insanity.     By  John  C.  Shaw,  M.  D.     Third 

edition,  revised. 

22.  Essentials  of    Medical    Physics.     By  Fred  J.   Brockway,  M.  D.     Second  edition, 

revised. 

23.  Essentials  of  Medical  Electricity.     By  David  D.  Stewart,  M.  D.,  and  Edward 

S.  Lawrance,  M.  D. 

24.  Essentials  of  Diseases  of  the  Ear.     By  E.  B.   Gleason,   M.  D.     Second   edition, 

revised  and  greatly  enlarged. 

25.  Essentials  of  Histology.     By  Louis  Leroy,  M.  D.     With  73  original  illustrations. 


Pamphlet  containing  specimen  pages,  etc.,  sent  free  upon  application. 

is 


Saunders'   Medical    Hand-Atlases. 


VOLUMES    NOW   READY. 

Atlas  and  Epitome  of  Internal  Medicine  and  Clinical 
Diagnosis. 

By  Dr.  Chr.  Jakob,  of  Erlangen.  Edited  by  Augustus  A.  Eshner, 
M.  D.,  Professor  of  Clinical  Medicine,  Philadelphia  Polyclinic.  With 
179  colored  figures  on  68  plates,  64  text-illustrations,  259  pages  of  text. 
Cloth,  $3.00  net. 

Atlas  of  Legal  Medicine. 

By  Dr.  E.  R.  von  Hofmann,  of  Vienna.  Edited  by  Frederick 
Peterson,  M.  D.,  Chief  of  Clinic,  Nervous  Department,  College  of 
Physicians  and  Surgeons,  New  York.  With  120  colored  figures  on  56 
plates  and  193  beautiful  half-tone  illustrations.      Cloth,  $3.50  net. 

Atlas  and  Epitome  of  Diseases  of  the  Larynx. 

By  Dr.  L.  Grunwald,  of  Munich.  Edited  by  Charles  P.  Grayson, 
M.  D.,  Physician-in-Charge,  Throat  and  Nose  Department,  Hospital  of 
the  University  of  Pennsylvania.  With  107  colored  figures  on  44  plates, 
25  text-illustrations,  and  103  pages  of  text.     Cloth,  $2.50  net. 

Atlas  and  Epitome  of  Operative  Surgery. 

By  Dr.  O.  Zuckerkandl,  of  Vienna.  Edited  by  J.  Chalmers 
DaCosta,  M.  D.,  Professor  of  Principles  of  Surgery  and  Clinical  Sur- 
gery, Jefferson  Medical  College,  Philadelphia.  With  24  colored  plates, 
217  text-illustrations,  and  395  pages  of  text.     Cloth,  $3.00  net. 

Atlas   and   Epitome   of    Syphilis    and   the   Venereal 
Diseases. 

By  Prof.  Dr.  Franz  Mracek,  of  Vienna.  Edited  by  L.  Bolton 
Bangs,  M.  D.,  Professor  of  Genito-Urinary  Surgery,  University  and 
Bellevue  Hospital  Medical  College,  New  York.  With  71  colored 
plates,  16  illustrations,  and  122  pages  of  text.     Cloth,  $3.50  net. 

Atlas  and  Epitome  of  External  Diseases  of  the  Eye. 

By  Dr.  O.  Haab,  of  Zurich.  Edited  by  G.  E.  de  Schweinitz,  M.  D., 
Professor  of  Ophthalmology,  Jefferson  Medical  College,  Philadelphia. 
With  76  colored  illustrations  on  40  plates  and  228  pages  of  text. 
Cloth,  $3.00  net. 

Atlas  and  Epitome  of  Skin  Diseases. 

By  Prof.  Dr.  Franz  Mracek,  of  Vienna.  Edited  by  Henry  W.  Stel- 
wagon,  M.  D.,  Clinical  Professor  of  Dermatology,  Jefferson  Medical 
College,  Philadelphia.  With  63  colored  plates,  39  half-tone  illustra- 
tions, and  200  pages  of  text.     Cloth,  $3.50  net. 

Atlas  and  Epitome  of  Special  Pathological  Histology. 

By  Dr.  H.  Durck,  of  Munich.  Edited  by  Ludwig  Hektoen  M.  D., 
Professor  of  Pathology,  Rush  Medical  College,  Chicago.  In  Two  Parts. 
Part  I.  Ready,  including  Circulatory,  Respiratory,  and  Gastro-intestinal 
Tract,  120  colored  figures  on  62  plates,  158  pages  of  text.  Part  II. 
Ready  Shortly.     Price  of  Part  I.,  $3.00  net. 

16 


Saunders'  Medical   Hand-Atlases* 


VOLUMES   JUST   ISSUED. 

Atlas  and  Epitome  of  Diseases  Caused  by  Accidents. 

By  Dr.  Ed.  Golebiewski,  of  Berlin.  Translated  and  edited  with  addi- 
tions by  Pearce  Bailey,  M.  D. ,  Attending  Physician  to  the  Department 
of  Corrections  and  to  the  Almshouse  and  Incurable  Hospitals,  New- 
York.  With  40  colored  plates,  143  text-illustrations,  and  600  pages 
of  text.     Cloth,  $4.00  net. 

Atlas  and  Epitome  of  Gynecology. 

By  Dr.  O.  Shaeffer,  of  Heidelberg.  From  the  Second  Revised  Ger- 
man Edition.  Edited  by  Richard  C.  Norris,  A.  M.,  M.  D.,  Gyne- 
cologist to  the  Methodist  Episcopal  and  the  Philadelphia  Hospitals; 
Surgeon-in-Charge  of  Preston  Retreat,  Philadelphia.  With  90  colored 
plates,  65  text-illustrations,  and  308  pages  of  text.     Cloth,  $3.50  net. 

Atlas   and  Epitome  of  the  Nervous  System  and  its 
Diseases. 

By  Professor  Dr.  Chr.  Jakob,  of  Erlangen.  From  the  Second  Re- 
vised and  Enlarged  German  Edition.  Edited  by  Edward  D.  Fisher, 
M.  D.,  Professor  of  Diseases  of  the  Nervous  System,  University  and 
Bellevue  Hospital  Medical  College,  New  York.  With  83  plates  and  a 
copious  text.     Cloth,  $3.50  net. 

Atlas  and  Epitome  of  Labor  and  Operative  Obstetrics. 

By  Dr.  O.  Schaeffer,  of  Heidelberg.  From  the  Fifth  Revised  and 
Enlarged  German  Edition.  Edited  by  J.  Clifton  Edgar,  M.  D.r 
Professor  of  Obstetrics  and  Clinical  Midwifery,  Cornell  University 
Medical  School.      With   126  colored  illustrations.      Cloth,  $2.00  net. 

Atlas    and     Epitome    of     Obstetric     Diagnosis     and 
Treatment. 

By  Dr.  O.  Schaeffer,  of  Heidelberg.  From  the  Second  Revised  and  En- 
larged German  Edition.  Edited  by  J.  Clifton  Edgar,  M.  D.,  Professor 
of  Obstetrics  and  Clinical  Midwifery,  Cornell  University  Medical  School. 
72  colored  plates,  text-illustrations,  and  copious  text.      Cloth,  $3.00  net. 

Atlas   and   Epitome   of   Ophthalmoscopy   and    Oph- 
thalmoscopic   Diagnosis. 

By  Dr.  O.  Haab,  of  Zurich.  From  the  Third  Revised  and  Enlarged 
German  Edition.  Edited  by  G.  E.  de  Schweinitz,  M.  D.,  Professor 
of  Ophthalmology,  Jefferson  Medical  College,  Philadelphia.  With  152 
colored  figures  and  82  pages  of  text.      Cloth,  $3.00  net. 

Atlas  and  Epitome  of  Bacteriology. 

Including  a  Text-Book  of  Special  Bacteriologic  Diagnosis.  By  Prof. 
Dr.  K.  B.  Lehmann  and  Dr.  R.  O.  Neumann,  of  Wurzburg.  From  the 
Second  Revised  German  Edition.  Edited  by  George  H.  Weaver,  M.  D., 
Assistant  Professor  of  Pathology  and  Bacteriology,  Rush  Medical  College, 
Chicago.  Two  volumes  with  over  600  colored  lithographic  figures, 
numerous  text-illustrations,  and  500  pages  of  text. 


ADDITIONAL  VOLUMES   IN   PREPARATION. 

17 


NOTHNAGEL'S   ENCYCLOPEDIA 

OF 

PRACTICAL   MEDICINE 

Edited  by  ALFRED   STENGEL,  M.  D. 

Professor  of  Clinical  Medicine  in  the  University  of  Pennsylvania;  Visiting 
Physician  to  the  Pennsylvania  Hospital 

IT  is  universally  acknowledged  that  the  Germans  lead  the  world  in  Internal 
Medicine  ;  and  of  all  the  German  works  on  this  subject,  Nothnagel's  "  Ency- 
clopedia of  Special  Pathology  and  Therapeutics"  is  conceded  by  scholars  to 
be  without  question  the  best  System  of  Medicine  in  existence.  So  necessary 
is  this  book  in  the  study  of  Internal  Medicine  that  it  comes  largely  to  this  country 
in  the  original  German.  In  view  of  these  facts,  Messrs.  W.  B.  Saunders  &  Com- 
pany have  arranged  with  the  publishers  to  issue  at  once  an  authorized  edition 
of  this  great  encyclopedia  of  medicine  in  English. 

For  the  present  a  set  of  some  ten  or  twelve  volumes,  representing  the  most 
practical  part  of  this  encyclopedia,  and  selected  with  especial  thought  of  the  needs 
of  the  practical  physician,  will  be  published.  The  volumes  will  contain  the  real 
essence  of  the  entire  work,  and  the  purchaser  will  therefore  obtain  at  less  than 
half  the  cost  the  cream  of  the  original.  Later  the  special  and  more  strictly 
scientific  volumes  will   be   offered  from  time  to  time. 

The  work  will  be  translated  by  men  possessing  thorough  knowledge  of  both 
English  and  German,  and  each  volume  will  be  edited  by  a  prominent  specialist 
on  the  subject  to  which  it  is  devoted.  It  will  thus  be  brought  thoroughly  up  to 
date,  and  the  American  edition  will  be  more  than  a  mere  translation  of  the  Ger- 
man ;  for,  in  addition  to  the  matter  contained  in  the  original,  it  will  represent  the 
very  latest  views  of  the  leading  American  specialists  in  the  various  departments 
of  Internal  Medicine.  The  whole  System  will  be  under  the  editorial  super- 
vision of  Dr.  Alfred  Stengel,  who  will  select  the  subjects  for  the  American  edition, 
and  will  choose  the  editors  of  the  different  volumes. 

Unlike  most  encyclopedias,  the  publication  of  this  work  will  not  be  extended 
over  a  number  of  years,  but  five  or  six  volumes  will  be  issued  during  the  coming 
year,  and  the  remainder  of  the  series  at  the  same  rate.  Moreover,  each  volume 
will  be  revised  to  the  date  of  its  publication  by  the  American  editor.  This  will 
obviate  the  objection  that  has  heretofore  existed  to  systems  published  in  a  number 
of  volumes,  since  the  subscriber  will  receive  the  completed  work  while  the  earlier 
volumes  are  still  fresh. 

The  usual  method  of  publishers,  when  issuing  a  work  of  this  kind,  has  been 
to  compel  physicians  to  take  the  entire  System.  This  seems  to  us  in  many  cases 
to  be  undesirable.  Therefore,  in  purchasing  this  encyclopedia,  physicians  will  be 
given  the  opportunity  of  subscribing  for  the  entire  System  at  one  time ;  but  any 
single  volume  or  any  number  of  volumes  may  be  obtained  by  those  who  do  not 
desire  the  complete  series.  This  latter  method,  while  not  so  profitable  to  the  pub- 
lisher, offers  to  the  purchaser  many  advantages  which  will  be  appreciated  by  those 
who  do  not  care  to  subscribe  for  the  entire  work  at  one  time. 

This  American  edition  of  Nothnagel's  Encyclopedia  will,  without  question, 
form  the  greatest  System  of  Medicine  ever  produced,  and  the  publishers  feel  con- 
fident that  it  will  meet  with  general  favor  in  the  medical  profession. 


'OF  W.  P 

NOTHNAGEL'S  ENCYCLOPEDIA 

VOLUMES  JUST  ISSUED  AND  IN  PRESS 


VOLUME  I 
Editor,  William  Osier,  M.  D„  F.  R.  C.  P. 

Professor  of  Medicine  in  fohns  Hopkins 
University 

CONTENTS 

Typhoid  Fever.  By  Dr.  H.  Curschmann, 
of  Leipsic.  Typhus  Fever.  By  Dr.  H. 
Curschmann,  of  Leipsic. 

Handsome  octavo  volume  of  about  600  pages. 
fist  Issued 


volume  vn 

Editor,  John  H.  Musser,  M.  D. 

Professor  of  Clinical  Medicine,  University  of 
Pennsylvania 

CONTENTS 

Diseases  of  the  Bronchi.  By  Dr.  F.  A.  Hoff- 
mann, of  Leipsic.  Diseases  of  the  Pleura. 
By  Dr.Roseneach,  of  Berlin.  Pneumonia. 
By  Dr.  E.  Aufrecht,  of  Magdeburg. 


VOLUME  II 

Editor,  Sir  J.  W.  Moore,  B.  A.,  M.D., 
F.R.C.P.I.,  of  Dublin 

Professor  of  Practice  of  Medicine,  Royal  College 
of  Surgeons  in  Ireland 

CONTENTS 

Erysipelas  and  Erysipeloid.  By  Dr.  H.Len- 
hartz,  of  Hamburg.  Cholera  Asiatica  and 
Chokra  Nostras.  By  Dr.  K.  von  Lieber- 
meister,  of  Tiibingen.  "Whoooing  Cough 
and  Hay  Fever.  By  Dr.  G.  Sticker,  of 
Giessen.  Varicella.  By  Dr.  Th.  von  Jcr- 
gensen,  of  Tiibingen.  Variola  1  including 
Vaccination).  Ey  Dr.  H.  Immermann,  of 
Basle. 

Handsome  octavo  volume  of  over  700  pages. 
Just  Issued 


VOLUME  VIII 
Editor,  Charles  G.  Stockton,  M.D. 

Professor  of  Medicine,  University  of  Buffalo 

CONTENTS 

Diseases  of  the  Stomach.    By  Dr.  F.  Riegel, 
of  Giessen. 


VOLUME  rx 
Editor,  Frederick  A.  Packard,  M.  D. 

Physician  to  the  Pen?isylvania  Hospital  and  to  the 
Children' s  Hospital,  Philadelphia 

CONTENTS 

Diseases  of  the  Liver.    By  Drs.  H.  Quincke 
and  G.  Hoppe-Seyler,  of  Kiel. 


VOLUME  in 
Editor,  'William  P.  Northrup,  M.  D. 

Professor  of  Pediatrics ,  University  and  Bellevue 
Medical  College 

CONTENTS 

Measles.  By  Dr.  Th.  von  Jurgensen,  of 
•Tubingen.  Scarlet  Fever.  By  the  same 
author.     Rotheln.    By  the  same  author. 


VOLUME  X 
Editor,  Reginald  H.  Fitz,  A.M.,  M.  D. 

Hersey  Professor  of  the  Theory  and  Practice 
of  Physic,  Harvard  University 

CONTENTS 

Diseases  of  the  Pancreas.  By  Dr.  L.  Oser, 
of  Vienna.  Diseases  of  the  Suprarenals. 
By  Dr.  E.  Xeusser,  of  Vienna. 


VOLUME  VI 
Editor,  Alfred  Stengel,  M.  D. 

Professor  of  Clinical  Medicine,  University  of 
Pennsylvania 

CONTENTS 

Anemia.  By  Dr.  P.  Ehrlich,  of  Frankfort  - 
on-the-Main,  and  Dr.  A.  Lazarus,  of  Char- 
lottenburg.  Chlorosis.  By  Dr.  K.  von 
Noorden,  of  Frankfort-on-the-Main.  Dis- 
eases of  the  Spleen  and  Hemorrhagic 
Diathesis.    By  Dr.  M.  Litten,  of  Berlin. 


VOLUMES  D7,  V,  and  XI 
Editors  announced  later 

ol.  IV. — Influenza  and  Dengue.  By  Dr.  0. 
Leichtenstern,  of  Cologne.  MalarialDis- 
eases.    By  Dr.  J.  Mannaberg,  of  Vienna. 

ol-  ^  • — Tuberculosis  and  Acute  General 
Miliary  Tuberculosis.  By  Dr.  G.  Cornet, 
of  Berlin. 

ol.  XL — Diseases  of  the  Intestines  and 
Peritoneum.  By  Dr.  H.  Nothnagel, 
of  Vienna. 


19 


CVrCL'S  £D  LIST 

OF  THE    - 

MEDICAL    PUBLICATIONS 


OF 


W.  B.  SAUNDERS  &  COMPANY 


ANATOMY,  EMBRYOLOGY, 

HISTOLOGY. 

Bohm,  Davidoff,  and  Huber — A  Text- 
Book  of  Histology 4 

Clarkson — A  Text-Book  of  Histology,  .    .  5 

Haynes — A  Manual  of  Anatomy 7 

Heisler — A  Text-Book  of  Embryology,  .    .  7 

Leroy — Essentials  of  Histology, 15 

Nancrede — Essentials  of  Anatomy 15 

Nancrede — Essentials    of    Anatomy    and 

Manual  of  Practical  Dissection,  ....  10 

BACTERIOLOGY. 

Ball — Essentials  of  Bacteriology 15 

Frothingham — Laboratory  Guide 6 

Gorham — Laboratory  Course  in    Bacteri- 

ologv 22 

Lehmann  and  Neumann — Atlas  of  Bacte- 
riology   17 

Levy  and  Klemperer's  Clinical  Bacteri- 
ology   9 

Mallory  and  Wright — Pathological  Tech- 
nique   9 

McFarland — Pathogenic  Bacteria,  ....  9 

CHARTS,  DIET-LISTS,  ETC. 

Griffith— Infant's  Weight  Chart, 7 

Hart — Diet  in  Sickness  and  in  Health,  .    .  7 

Keen — Operation  Blank, 8 

Laine — Temperature  Chart,   .' 9 

Meigs — Feeding  in  Early  Infancy 10 

Starr — Diets  for  Infants  and  Children,  .    .  12 

Thomas — Diet-Lists, 13 

CHEMISTRY  AND  PHYSICS. 

Brockway — Essentials  of  Medical  Ph}-sics,  15 

Wolff — Essentials  of  Medical  Chemistry,  .  15 

CHILDREN. 
An  American  Text-Book  of  Diseases  of 

Children 1 

Griffith — Care  of  the  Baby 7 

Griffith— Infant's  Weight  Chart 7 

Meigs — Feeding  in  Early  Infancy,  ....  10 

Powell — Essentials  of  Diseases  of  Children,  15 

Starr — Diets  for  Infants  and  Children,  .    .  12 

DIAGNOSIS. 

Cohen  and  Eshner — Essentials  of  Diag- 
nosis   15 

Corwin — Physical  Diagnosis 5 

Vierordt — Medical  Diagnosis 14 

DICTIONARIES. 
The  American  Illustrated  Medical  Dic- 
tionary   3 

The  American  Pocket  Medical  Dictionary,  3 

Morten — Nurses'  Dictionary 10 


EYE,  EAR,  NOSE,  AND  THROAT. 

An  American  Text-Book  of  Diseases  of 

the  Eye,  Ear,  Nose,  and  Throat 1 

De  Schweinitz — Diseases  of  the  Eye,    .    .  6 
Friedrich  and  Curtis — Rhinoiogy,  Laryn- 
gology and  Otology, 6 

Gleason — Essentials  of  Diseases  of  the  Ear,  15 

Gleason — Ess.  of  Dis.  of  Nose  and  Throat,  15 

Gradle — Ear.  Nose,  and  Throat 22 

Griinwald    and    Grayson— Atlas  of  Dis- 
eases of  the  Larynx 16 

Haab  and  De  Schweinitz — Atlas  of  Exter- 
nal Diseases  of  the  Eye 16 

Haab  and  De  Schweinitz— Atlas  of  Oph- 
thalmoscopy,       17 

Jackson — Manual  of  Diseases  of  the  Eye,  8 

Jackson — Essentials   of  Diseases  of  Eye,  15 

Kyle — Diseases  of  the  Nose  and  Throat,  .  9 

GENITO-URINARY. 

An  American  Text-Book  of  Genito-Uri- 

naryand  Skin  Diseases 2 

Hyde'and  Montgomery — Syphilis  and  the 

Venereal  Diseases, 8 

Martin — Essentials     of    Minor     Surgery, 

Bandaging,  and  Venereal  Diseases,  ...  15 
Mracek  and  Bangs — Atlas  of  Syphilis  and 

the  Venereal  Diseases, 16 

Saundby — Renal  and  Urinary  Diseases,  .   .  11 

Senn — Genito-Urinary  Tuberculosis,  ...  12 

Vecki — Sexual  Impotence 14 

GYNECOLOGY. 

American  Text-Book  of  Gynecology,    .    .  2 

Cragin — Essentials  of  Gynecology 15 

Garrigues — Diseases  of  Women 6 

Long — Syllabus  of  Gynecology 9 

Penrose — Diseases  of  Women 10 

Pryor — Pelvic  Inflammations 11 

Sshaeffer  &  Norris — Atlas  of  Gynecology,  17 

HYGIENE. 
Abbott — Hvgiene  of  Transmissible  Diseases    3 

Bergey — Principles  of  Hygiene, 22 

Pyle — Personal  Hygiene, 11 

MATERIA  MEDICA,  PHARMACOL- 
OGY, AND  THERAPEUTICS. 

American  Text-Book  of  Therapeutics,  .    .  1 
Butler — Text-Book    of    Materia    Medica, 

Therapeutics,  and  Pharmacology,    ...  4 

Morris — Ess.  of  M.  M.  and  Therapeutics,  15 

Saunders'  Pocket  Medical  Formulary,  .    .  11 

Sayre — Essentials  of  Pharmacy 13 

Sollmann — Text- Book  of  Pharmacology,  .  22 

Stevens — Manual  of  Therapeutics,    ...  13 

Stoney — Materia  Medica  for  Nurses,    .    .  13 

Thornton — Prescription- Writing 13 


MEDICAL  PUBLICATIONS  OF  W.  B.  SAUNDERS  &  CO. 


MEDICAL  JURISPRUDENCE  AND 
TOXICOLOGY. 

Chapman — Medical  Jurisprudence  and 
Toxicology 5 

Golebiewski  and  Bailey — Atlas  of  Dis- 
eases Caused  by  Accidents 17 

Hofmann  and  Peterson— Atlas  of  Legal 
Medicine 16 

NERVOUS  AND  MENTAL 
DISEASES,  ETC. 

Brower — Manual  of  Insanity 22 

Chapin — -Compendium  of  Insanity,    ...  5 
Church  and  Peterson — Nervous  and  Men- 
tal Diseases 5 

Jakob  &  Fisher — Atlas  of  Nervous  System,  17 
Shaw — Essentials  of  Nervous  Diseases  and 

Insanity 15 

NURSING. 

Davis — Obstetric  and  Gvnecologic  Nursing,  6 

Griffith— The  Care  of  the  Baby 7 

Hart — Diet  in  Sickness  and  in  Health,   .    .  7 

Meigs — Feeding  in  Early  Infancy,  ....  10 

Morten — Nurses'  Dictionary 10 

Stoney — Materia  Medica  for  Nurses,      .    .  13 

Stoney — Practical  Points  in  Nursing,  ...  13 

Stoney — Surgical  Technic  for  Nurses,    .    .  13 

Watson — Handbook  for  Nurses 14 

OBSTETRICS. 

An  American  Text-Book  of  Obstetrics 
Ashton — Essentials  of  Obstetrics, 

Boisliniere — Obstetric  Accidents 4 

Dorland— Modern  Obstetrics, 6 

Hirst — Text-Book  of  Obstetrics, 
Norris — Syllabus  of  Obstetrics, 
Schaeffer  and  Edgar — Atlas  of  Obstetri- 
cal Diagnosis  and  Treatment 17 

PATHOLOGY. 

An  American  Text-Book  of  Pathology,  .  2 
Diirck  and  Hektoen — Atlas  of  Pathologic 

Histology, 16 

Kalteyer— Essentials  of  Pathology,    ...    15 
Mallory  and  Wright — Pathological  Tech- 
nique  9 

Senn — Pathology  and  Surgical  Treatment 

of  Tumors 12 

Stengel — Text-Book  of  Pathology,     ...    12 
Warren — Surgical  Pathology  and  Thera- 
peutics  14 

PHYSIOLOGY. 

An  American  Text-Book  of  Physiology,  2 
Budgett — Essentials  of  Physiology,  ...  15 
Eaymond — Text-Book  of  Physiology,  .  .  n 
Stewart— Manual  of  Physiology,    .    ...    13 

PRACTICE  OF  MEDICINE. 
An  American  Year-Book  of  Medicine  and 

Surgery 3 

Anders — Practice  of    Medicine, 4 

Eichhorst — Practice  of  Medicine 6 

Lockwood — Manual    of    the    Practice    of 

Medicine 9 

Morris — Ess.  of  Practice  of  Medicine,  .    .    15 
Salinger   and  Kalteyer — Modern   Medi- 
cine  11 

Stevens — Manual  of  Practice  of  Medicine,    13 


SKIN  AND  VENEREAL. 

An  American  Text-Book  of  Genito- 
urinary and  Skin  Diseases 2 

Hyde  and  Montgomery — Syphilis  and  the 
Venereal  Diseases 8 

Martin —  Essentials  of  Minor  Surgery, 
Bandaging,  and  Venereal  Diseases,     .    .    15 

Mracek  and  Stelwagon — Atlas  of  Diseases 
of  the  Skm 16 

Stelwagon — Essentials  of  Diseases  of  the 
Skin 15 

SURGERY. 

An  American  Text-Book  of  Surgery,  .  .  2 
An  American  Year-Book  of  Medicine  and 

Surgery 3 

Beck — Fractures 4 

Beck — Manual  of  Surgical  Asepsis,    ...  4 

Da  Costa — Manual  of  Surgery 5 

International  Text-Book  of  Surgery,  .    .  8 

Keen — Operation  Blank 8 

Keen — The    Surgical    Complications   and 

Sequels  of  Typhoid  Fever 8 

Macdonald — Surgical  Diagnosis  and  Treat- 
ment   9 

Martin —  Essentials    of    Minor    Surgery, 

Bandaging,  and  Venereal  Diseases,      .    .  15 

Martin— Essentials  of  Surgery, 15 

Moore — Orthopedic  Surgery, 10 

Nancrede — Principles  of  Surgery 10 

Pye — Bandaging  and  Surgical  Dressing,     .  11 

Scudder — Treatment  of  Fractures,     ...  12 

Senn — Genito-Urinary  Tuberculosis,  ...  12 

Senn — Practical  Surgery, 12 

Senn — Syllabus  of  Surgery,  . 12 

Senn — Pathology  and  Surgical  Treatment 

of  Tumors 12 

Warren — Surgical  Pathology  and  Thera- 
peutics   14 

Zuckerkandl   and    Da    Costa — Atlas    of 

Operative  Surgery, 16 

URINE  AND  URINARY  DISEASES. 

Ogden — Clinical  Examination  of  the  Urine,    10 
Saundby — Renal  and  Urinary  Diseases,    .    11 
Wolff —  Handbook     of      Urine-Examina- 
tion,      22 

Wolff —  Essentials     of     Examination     of 
Urine,      15 

MISCELLANEOUS. 

Bastin — Laboratory  Exercises  in  Botany,  .     4 
Golebiewski  and  Bailey — Atlas  of  Dis- 
eases Caused  by  Accidents 17 

Gould  and  Pyle— Anomalies  and  Curiosi- 
ties of  Medicine 7 

Grafstrom — Massage 7 

Keating — How  to  Examine  for  Life  Insur- 
ance,          8 

Saunders'  Medical  Hand-Atlases,  .  .  16,17 
Saunders'  Pocket  Medical  Formulary,  .  .  11 
Saunders'  Question-Compends,  .  .  .  14,15 
Stewart    and    Lawrence— Essentials    of 

Medical  Electricity 15 

Thornton— Dose-Book    and    Manual    of 

Prescription-Writing,      13 

Van  Valzah  and  Nisbet— Diseases  of  the 
Stomach, 13 


THE  LATEST  BOOKS. 


Bergey's  Principles  of   Hygiene. 

The  Principles  of  Hygiene :  A  Practical  Manual  for  Students,. 
Physicians,  and  Health  Officers.  By  D.  H.  Bergey,  A.  M.,  M.  D., 
First  Assistant,  Laboratory  of  Hygiene,  University  of  Pennsyl- 
vania.     Handsome  octavo  volume  of  about  500  pages,  illustrated. 

Brower's  Manual  of  Insanity. 

A  Practical  Manual  of  Insanity.  By  Daniel  R.  Brower,  M.  D., 
Professor  of  Nervous  and  Mental  Diseases,  Rush  Medical  College,. 
Chicago.      i2mo  volume  of  425  pages,  illustrated. 

Gorham's  Bacteriology. 

A  Laboratory  Course  in  Bacteriology.  By  F.  P.  Gorham,  M.  A.,. 
Assistant  Professor  in  Biology,  Brown  University.  i2mo  volume 
of  about  160  pages,  handsomely  illustrated. 

Gradle  on  the  Nose,  Throat,  and  Ear. 

Diseases  of  the  Nose,  Throat,  and  Ear.  By  Henry  Gradle,. 
M.  D.,  Professor  of  Ophthalmology  and  Otology,  Northwestern 
University  Medical  School,  Chicago.  Handsome  octavo  volume 
of  800  pages,  profusely  illustrated. 

Sollmann's  Pharmacology. 

A  Text-Book  of  Pharmacology.  By  Torald  Sollmann,  M.  D.r 
Lecturer  on  Pharmacology,  Western  Reserve  University,  Cleve- 
land, Ohio.     Royal  octavo  volume  of  about  700  pages. 

Wolfs  Examination  of   Urine. 

A  Handbook  of  Physiologic  Chemistry  and  Urine  Examination. 
By  Chas.  G.  L.  Wolf,  M.  D.,  Instructor  in  Physiologic  Chemistry, 
Cornell  University  Medical  College.  i2mo  volume  of  about  160 
pages. 


DUE  DATE 

Printed 
in  USA 

